Holistic Sports Massage Workbook

Introduction & Overview
Welcome to the Holistic Massage Diploma with Brighton School of Massage. To pass this
course, you will need to complete each of the following sections:
Unit Study Method Assessment
Holistic body massage Online study and Total of 36 case study treatments: Pass / Refer
(Theory & Practical) practical lessons Multiple choice question exam (60 mins)
Practical massage exam (60 mins)
Anatomy & Physiology Online study Pathology Assignment: Pass / Refer

Multiple choice question papers after each body
system
Complementary therapies Online study Assignment: Pass / Refer
Business practice Online study Assignment: Pass / Refer
Guidance Notes:
Lessons
Whilst every effort has been made to balance the content across lessons, some lessons may
require more time to complete than others.
Workbook
You can download a supplementary workbook to use while you review the content of this
course. It is by no means compulsory but may help you to organise your learning and use for
revision and review.
Tasks
Throughout this unit there are optional, unassessed learning activities to consolidate your
learning. These are purely for your own benefit and are not submitted. Mostly, you will find
supporting resources for completing the tasks in the printable handbook.
Test
Most lessons have a compulsory test to complete to assess your learning and support your
revision.
Assessment
An assessment is a compulsory assignment which needs to be submitted for grading.
Assessments will be graded ‘pass’ or ‘refer’. Assessments are detailed in separate
Assessment Guidance documents.
Exam
Exams are assessments that are graded as a percentage mark and will be arranged with your
lecturer. For this unit, you will have a practical exam and a multiple-choice question (MCQ)
exam made up of 50 questions. The theory exam is online. The practical exam is in class.
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Table of Contents
Introduction & Overview ................................................................................................................ 2
Guidance Notes: .............................................................................................................................. 2
Lesson 1: Introduction to Massage ......................................................................................................... 6
What is massage? ........................................................................................................................... 6
Origins and History of Massage Timeline ....................................................................................... 8
Effects and Benefits of Massage ..................................................................................................... 9
The link between Holistic / Therapeutic massage and Traditional Swedish massage .................. 11
Lesson 2: Professional practise in massage .......................................................................................... 14
Relevant Acts……………………………………………………………………………………………………………………… ..... 15
Health & Safety in Practice ........................................................................................................... 23
Risk Assessment ............................................................................................................................ 23
Areas to consider .......................................................................................................................... 27
Chemical Hazard Symbols ............................................................................................................. 28
Hygiene ......................................................................................................................................... 29
Lesson 3: Looking after yourself ........................................................................................................... 30
How can massage therapists protect and take care of themselves? ........................................... 30
Lone Working ................................................................................................................................ 35
Standards relevant to massage…………………………………………………………………………………………………36
Lesson 4: Preparing for Massage .......................................................................................................... 38
Business Requirements in preparation for massage therapy. ...................................................... 39
Professionalism ............................................................................................................................. 40
Preparing Yourself – Therapist Presentation ................................................................................ 41
Lesson 5: Massage Equipment .............................................................................................................. 43
Equipment for massage ................................................................................................................ 44
Creating a professional massage environment............................................................................. 45
Your massage couch...................................................................................................................... 49
Safe Equipment ............................................................................................................................. 50
Lesson 6: Massage Mediums ................................................................................................................ 51
Massage Mediums ........................................................................................................................ 56
Lesson 7: Massage and the Body .......................................................................................................... 59
Systems directly affected by massage .......................................................................................... 59
Systems indirectly affected. .......................................................................................................... 62
Lesson 8: Understanding Muscles ........................................................................................................ 65
The Muscular System .................................................................................................................... 65
Posture Types ............................................................................................................................... 72
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Musculo-Skeletal Problems........................................................................................................... 72
Soft Tissue Dysfunction ................................................................................................................. 73
Muscles of the body ...................................................................................................................... 74
Example Actions of Muscles ......................................................................................................... 80
Lesson 9: The Skin ................................................................................................................................. 85
The Skin Structure ......................................................................................................................... 85
Diagram of the Skin ....................................................................................................................... 87
Skin Types...................................................................................................................................... 88
Skin Colouring and Presentations ................................................................................................. 91
Skin Diseases and Disorders .......................................................................................................... 92
Lesson 10: Contra-indications to Massage ........................................................................................... 93
Informed consent.......................................................................................................................... 94
Types of contraindications ............................................................................................................ 97
Contraindications to Massage Treatment .................................................................................... 99
Lesson 11: Consulting the Client ......................................................................................................... 106
Preparing for Consultation .......................................................................................................... 106
Communication ........................................................................................................................... 107
What should the consultation include? ...................................................................................... 109
Physical Assessment.................................................................................................................... 110
Asking for Personal Information ................................................................................................. 113
Consent ....................................................................................................................................... 114
Confidentiality ............................................................................................................................. 115
Referral to other practitioners .................................................................................................... 115
Lesson 12: Planning a Treatment ........................................................................................................ 118
Treatment Routine ...................................................................................................................... 118
Adapting a treatment.................................................................................................................. 118
Devising a treatment plan ........................................................................................................... 119
Lesson 13: Massage Techniques ......................................................................................................... 120
Preparing the client for massage ................................................................................................ 120
Massage Movements .................................................................................................................. 121
Lesson 14: Contra-actions and Client Aftercare ................................................................................. 134
During Treatment........................................................................................................................ 134
After Treatment .......................................................................................................................... 135
Treatment Findings ..................................................................................................................... 136
Healing Crisis ............................................................................................................................... 136
Aftercare Advice.......................................................................................................................... 136
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Home Care Advice ....................................................................................................................... 137
Stretches ..................................................................................................................................... 137
Lesson 15: Evaluating and Recording Treatments .............................................................................. 139
Evaluating Treatments ................................................................................................................ 139
Record Keeping ........................................................................................................................... 140
Data Protection ........................................................................................................................... 142
Lesson 16: Professional Development: Reflective Practice & Lifelong Learning ................................ 144
What is reflective practice? ........................................................................................................ 144
Our attitudes, beliefs, and values ............................................................................................... 145
Why be reflective? ...................................................................................................................... 145
When should we practice self-reflection? .................................................................................. 146
How to be reflective.................................................................................................................... 146
Models of Reflection ................................................................................................................... 147
Methods of Reflective Practice ................................................................................................... 151
Goal Setting ................................................................................................................................. 152
Applying Reflective Practice to your Massage Course ................................................................ 154
Lifelong Learning ......................................................................................................................... 154
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Lesson 1: Introduction to Massage
OBJECTIVES OF THIS LESSON

L.1 OBJECTIVES
• Describe
Describe the history,
the history, philosophy
philosophy and roleand role of body
of massage therapy
massage and to
and its relationships itsother
relationship
massageto traditions.
other massage
traditions.
Describe the objectives and possible benefits of body massage
• Describe the objectives and possible benefits of body
treatment.
massage treatment.
What is massage?
Body massage is a form
of manipulation of the
soft tissues of the body,
which has been
developed over
thousands of years.
From ancient China to
present-day Europe, it
has been used around
the world, across the ages
for the promotion and
restoration of health.
Massage can be used for
relaxation, stimulation
or rehabilitation of the whole body or part of it. It promotes suppleness of the muscles,
improves circulation and reduces stress.
Holistic massage that we know today has developed over thousands of years and
includes influence from many different cultures.
How massage can complement other therapies and treatments
Massage can be used alongside a number of other therapies and treatments as a
complementary therapy. When included as part of a client's treatment and recovery
plan it can assist and support the healing process.
(©) Copyright 2022 Brighton School of Massage. All Rights Reserved.

Brighton School of Massage ® Is a registered trademark.
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Massage can be used alongside:
Medical therapies Including physiotherapy, osteopathy, occupational

therapy and chiropractic treatments to assist healing
of soft tissue structures and chronic and acute
injuries.
Physical therapies For example yoga therapy, Pilates, exercise therapy,

personal training, strength training and conditioning
to assist relaxation, recovery and healing.
Talking and psychological Including counselling, drama therapy and dance

therapies movement therapy to promote relaxation and
connection with the physical body and reduce tension
in the body created by general anxiety-related
Other alternative therapies conditions.
For example, Somatics, Reiki, energy medicine,

aromatherapy, crystal healing, hypnotherapy, Pilates,
herbalism, yoga therapy, reflexology, to aid with
holistic healing.
Task: History of Massage
Review the attached history of massage timelines. Highlight

three things that you did not previously know about
massage. Write a summary of the background of massage in
no more than two paragraphs.
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Origins and History of Massage Timeline
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Effects and Benefits of Massage
At a glance
Massage aids circulation, mobilizes joints and
muscles, improves digestion and, through increasing
relaxation, can improve and maintain general good
health and well-being.
Even though we look at the effects of massage on the separate body systems and life
forces, it must be recognized that they work together as a whole.
They are interdependent of each other.
Massage is said to be soothing, stimulating, instinctive, comforting, universal and safe. Most
people can benefit from massage treatment, and it is a non-invasive natural therapy with
increasingly documented benefits. It is thought to be instinctive as when we injure
ourselves, it is common to rub and manipulate the area using our own hands to soothe our
achy muscles.
The effects and benefits of massage can be split into physiological effects and psychological
benefits.
Physiological benefits of massage

Massage stimulates the systems of the body. It promotes better circulation, aids
digestion, encourages waste removal and supports neural communication (Tucker,
2016).
Massage uses touch to relax the body. Extended

periods of stress can lead to illness. Studies suggest
that stress is the “common risk factor of 75%-90% of
diseases” (Liu, Wang and Jiang, 2017), so we should
certainly aim to reduce stress in our lives. The
comforting touch of massage can help reduce stress
and promote well-being.
Massage stimulates blood circulation and assists the

lymphatic system. This aids the elimination of waste throughout the body.
When soothing movements such as effleurage are used, the touch receptors close to
the epidermis may signal the brain that there is no danger which may cause the body to
relax.
Deeper into the soft tissue, tension may be eased, adhesions broken down and muscles
may be free to contract more efficiently. Massage can relieve accumulated tension,
restore flexibility to tight, sore muscles and improve muscle tone. It also aids stretching
of connective tissue and increases tissue metabolism.
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Massage can relieve cramps and muscle spasms and reduces pain and swellings by
stimulating the release of endorphins (the body’s natural painkiller) into the brain and
nervous system. Fosters faster healing of strained muscles and sprained ligaments by
preventing and reducing excessive scar tissue.
Through relaxation, massage can slow and regulate respiration, promoting deeper and
easier breathing. In turn, this increases the flow of oxygen and nutrients to cells and tissue.
It can also lower blood pressure and reduce the heart rate.
Massage relieves tired and aching muscles and decreases muscular deterioration.
Through active movements, massage also increases joint mobility and range of
movement. Massage also improves skin tone by causing desquamation of the skin.
Massage may stimulate the immune system and strengthen resistance to disease. A study
(Shor-Posner et al., 2006) found that massage boosted the number of white blood cells in
patients with HIV, which typically causes a reduction of white blood cells. A study by the
BBC tested the effect of massage on people with no serious immune condition and
found that participants showed a 70% boost in their white blood cells after a one-hour
massage (D’Acquisto, 2017). Studies, at least as far back as the 1890s, have also shown
increased red blood cell count after massage.
Remember
Therapists must not diagnose or claim to
treat, heal, or cure medical conditions,
unless medically qualified to do so.
Psychological benefits of massage

The psychological benefits of massage can be as much
caused by the physiological effects of massage, as they do
contribute to them. For example, the decreased heart rate
and lower blood pressure can reduce levels of anxiety, but
also reduced levels of anxiety can help lower resting heart
rate and decrease blood pressure. This is known as a positive
feedback loop.
As much as the reduction of stress have physiological

benefits, there are psychological benefits from a massage
treatment which lowers stress levels. Reduced stress levels
can lead to better sleep patterns, which in turn boost physical wellbeing. Lower stress and
better sleep can aid concentration and focus, often leading to greater sense of achievement
and productivity.
A massage treatment can provide an opportunity for mindfulness and grounding

exercises, possibly enhancing capacity for calm thinking and creativity. It can offer a
chance to prioritize time to reflect on one’s own emotions and general wellbeing.
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The use of touch can be comforting for people of all ages, and massage can offer a
treatment which can either stimulate or calm the nervous system, depending on what is
needed. It can either be relaxing and reassuring, providing a sense of comfort and
destress through touch, or it can be refreshing and rejuvenating, boosting energy
through invigoration of the body systems.
Massage provides a soothing and comforting alternative or addition to verbal therapeutic

techniques, such as coaching or counselling. It can boost confidence, self-esteem, and a
general feeling of well-being. Due to the physical nature of body massage, it can increase
body awareness in the client, and may even mean early identification of health conditions.
Spiritual and energetic benefits of massage.

For some, massage provides an increased awareness of the mind-body-spirit
connection. The emotional and spiritual part of a person can be understood in
many ways, all of which are personal and individual. Our spirit finds its
regeneration in positive touch and can be renewed through touch. A giver’s touch
reflects their spirit as does the receiver’s ability and openness to receive it.
Whilst it is uncommon for massage to evoke negative effects, occasionally contra-actions

are experienced. This will be explored later in the course.
Task: Benefits of Massage
In your own words, summarise three physiological and

three psychological benefits of massage.
The link between Holistic / Therapeutic massage and Traditional Swedish

massage
The term holistic is generally interpreted as a treatment related to the whole person.
Typically, holistic treatments include a broader consultation that engages with various
elements of the client’s lifestyle and ensure that various aspects of, and approaches to,
massage are incorporated to meet the needs of the client. Holistic or therapeutic massage
has a practical application based primarily on the principles of Swedish massage but may
include elements of sports/deep tissue massage, lymphatic drainage techniques, or other
elements from different therapies, provided the therapist is adequately trained in these
approaches.
The psychological application of holistic/therapeutic massage is based on holistic concepts
of the universe. These may come from insights of Daoism which offers a set of practises
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designed to cure illness and maintain health and well-being. So, a holistic treatment aims to
connect body mind and spirit using an incorporated approach from different schools of
thought.
Practically, holistic/therapeutic massage includes movements that are performed slowly,
with light-medium pressure and normally incorporate the use of an oil-based massage
medium. Music and candlelight are often used as a background aid to support a calming
atmosphere. Active movements such as joint manipulation, stretches and myofascial
bodywork are usually not included in a holistic massage treatment.
Conversely, Swedish massage does include active exercise and is traditionally performed
with talcum powder to allow the therapist to perform these movements without slipping.
A combination of effleurage, petrissage, percussion, and friction movements are used
together with joint manipulation, passive and active exercises, stretches and deep tissue
work to relax, stimulate, and tone the body, whilst promoting positive physiological and
psychological effects.
Essentially, Swedish massage is an approach to body massage whose passive movements
are typically incorporated in holistic massage. Some therapists offer treatments called
holistic Swedish treatments.
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References
D'Acquisto, F., 2018. Could Massage Boost Your Immune System? [online] bbc.co.uk. Available at:
<https://www.bbc.co.uk/programmes/articles/5J0WJKFqPT3VCN9KwzbQCFd/could-massage-boost-
your-immune-system> [Accessed 2 January 2021].
Liu, Y., Wang, Y. and Jiang, C., 2017. Inflammation: The Common Pathway of Stress-Related
Diseases. Frontiers in Human Neuroscience, [online] 11(316). Available at:
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476783/> [Accessed 2 January 2021].
Shor-Posner, G., Hernandez-Reif, M., Miguez, M., Fletcher, M., Quintero, N., Baez, J., Perez-Then, E.,
Soto, S., Mendoza, R., Castillo, R. and Zhang, G., 2006. Impact of a Massage Therapy Clinical Trial on
Immune Status in Young Dominican Children Infected with HIV-1. The Journal of Alternative and
Complementary Medicine, 12(6), pp.511-516. Tucker, L., 2016. An Introductory Guide to Massage.
3rd ed. London: EMS Publishing, pp.8-10.
2019. History of Massage Therapy: Natural Healers Since 5000 Years. [online] Florida Academy.
Available at: <https://florida-academy.edu/history-of-massage-therapy> [Accessed 2 January 2021].
Thebodyworker.com. n.d. The History Of Massage And Bodywork. [online] Available at:
<http://www.thebodyworker.com/history.htm> [Accessed 1 January 2021].
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Lesson 2: Professional Practise in Massage
▪ Understand how to produce, maintain and store client records

▪ Understand the principles of professional practice in massage
▪ Understand the legislation required in massage
▪ Understand the standards relevant to the massage profession
▪ Understand the scope of practice in massage
Legal Obligations
As a professional Massage Therapist we are governed by various legislations which

outline the duty of care and attention to be provided by all employers and employees
providing professional services.
Duty of care means that to the best of one's knowledge and ability all
appropriate safeguards are in place and relevant precautions have been taken
to minimise risk or harm to a client or their property.
The massage therapist must be aware of the legislation and how it applies to their
role in different environments, which may include working as an employed or self-
employed therapist in a salon, sports facility, at a sporting event, from their own
home or as a mobile service provider. They must also ensure that their practice
complies with legislation.
Failure to comply with legislation may result in:

• Loss of professional memberships
• Loss of right to practise
• Prosecution and penalties
• Personal injury or other liability claims
• Invalid insurance
• Loss of livelihood
• Loss of reputation
• A criminal record
• Damage to the reputation of the whole sector and profession
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Relevant Acts of Parliament
The Management of Health and Safety at Work Regulations (1999) generally makes more
explicit what employers are required to do to manage health and safety under the Health
and Safety at Work Act. Employers should make formal arrangements for maintaining and
improving safe working conditions and practices. This includes competency training and risk
assessments.
COSHH - Control of Substances Hazardous to Health (2002) is the law that requires
employers to control substances that are hazardous to health.
A substance is considered to be hazardous if it can cause harm to the body. It poses a
risk if it is inhaled, ingested, in contact with the skin, absorbed through the skin,
injected into the body or introduced to the body through cuts.
Ensuring the following are in place:
• COSHH storage area which is fire proof and lockable
• Risk assessment carried out for each product which falls under COSHH
{cleaning products, bleach etc.)
• Protective clothing necessary when using products, e.g. gloves, goggles,
apron etc
• Training for staff using products
• Antidotes for any products, if there are any and where appropriate
• Store all substances safely and securely
• Use labels to identify substances {including allergens that may be present in
different oils or lotions)
RIDDOR - Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (2013)

puts duties on employers, the self-employed and people in control of work premises (the
Responsible Person) to report certain serious workplace accidents, occupational diseases
and specified dangerous occurrences (near misses).
Not all injuries need to be reported: only those where an accident is work-related
(not simply ‘at work’) and results in a specific type of injury or lead to incapacitation
for greater than seven days. Accidents must be recorded (but are not required to be
reported) where they result in a worker being incapacitated for more than 3
consecutive days.
Accidents to members of the public must be reported if they result in an injury and
the person is taken directly from the scene of the accident to hospital for treatment.
There is no need to report incidents where people are taken to hospital purely as a
precaution when no injury is apparent.
Employers and self-employed people must report diagnoses of certain occupational
diseases, where these are likely to have been caused or made worse by their work.
This includes carpal tunnel syndrome and tendonitis of the hand or forearm amongst
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others. Certain ‘near-miss’ incidents even though they did not result in injury, need
to be reported under RIDDOR.
Key guidelines :
• Have a policy and procedure for dealing with occupational accidents or
incidents
• Maintain an accident and incident report book
• Report any occupational diseases
• Report any contagious diseases or accidents at work, death,
non-fatal accidents, near misses or dangerous occurrences
• Report all incidents to HSE within ten days. This can be completed online
Manual Handling Operations Regulations (1992).

Key guidelines include:
• Provide a policy and procedure for manual handling
• Conduct regular risk assessments relating to manual handling
• Display safe handling information (posters), where appropriate
• Use a trolley to move portable couches
• Use hydraulic couches to protect posture where possible
• Provide manual handling training for staff, e.g. if using a stretcher pitch side
or at sporting events.
• Use appropriate techniques to move clients, e.g. help may be required and
care taken when moving disabled or elderly on and off couch
• When lifting and carrying equipment (e.g. mobile service or to sporting
events) use correct technique and use multiple journeys, rather than
carrying too much in one go
Electricity at Work Regulations (1989) apply to almost all places of work. Essentially
electrical equipment
• must be properly installed and maintained so that it does not present a risk of
electric shock, burns, fire or explosion when properly used. This includes the
commissioning of external services.
The Health and Safety (First-Aid) Regulations (1981) require employers to provide
adequate and appropriate equipment,
facilities and personnel to ensure their
employees receive immediate attention
if they are injured or taken ill at work.
These Regulations apply to all
workplaces including those with less
than five employees and to the self-
employed.
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Ensuring that the following are in place:
•Qualified and named first aider (to check and maintain first aid box)
•First aid room {depending on number of employees)
•Emergency contact numbers for all staff and service users
•First aid box accessible and fully stocked, appropriate for number of employees and
specific requirements
Minimum contents, where there are no special risks should include:
▪ Guidance leaflet
▪ 1 pair of disposable gloves
▪ 2 sterile eye pads
▪ 4 individually wrapped triangular bandages
▪ 6 safety pins
▪ 6 medium sized and 2 large individually wrapped, sterile wound
dressings
▪ 20 individually wrapped sterile adhesive dressings of various sizes
Noise at Work Regulations 1989

• Protection is offered to minimise any potential hearing damage in noisy
environments, e.g. use of ear covering at noisy events, such as motor
racing
The Equality Act 2010
This is the overarching legislation for equality and diversity, it encompasses

all previous legislation, e.g. Race Relations Act and Disability Discrimination
Act, etc.
Key guidelines:
• Treat people with respect and dignity, regardless of difference
• Do not discriminate against any person because of specific characteristics, e.g.
age, gender, race, religious beliefs, sexual orientation, disability
• Treat people fairly and with equal importance, including the provision of
reasonable adjustments, where possible and practicable
• Follow appropriate procedures to report any discriminatory behaviour in the
workplace
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The Local Government Act 1992 Any person carrying out invasive
treatments should be registered with the local authority.
Key guidelines:
• All services should be conducted at the registered premises
• All professionals should adhere to Health and Safety Executive (HSE) legislation
• Appropriate standards of personal and clinical hygiene should be maintained
• A first aider should be available when providing services
• All professionals should adhere to procedures for handling data and personal
information
• Appropriate insurances should be held by those offering services, e.g. public
liability
Employers' Liability (Compulsory Insurance) Act 1969
Key guidelines:
• Hold current insurance appropriate for the number of staff employed
• Display the insurance policy
Provision and Use of Work Equipment Regulations 1998
Key guidelines include ensuring:

• All equipment is regularly maintained and operational
• Appropriate testing of electrical equipment, e.g. PAT testing
The Regulatory Reform (Fire Safety) Order 2005

• Exit routes are clearly signposted and illuminated
• There is a fire alarm raising point
• There is adequate firefighting equipment
• Extinguishers are serviced regularly
• Evacuation routes and assembly points are clearly visible in each room
• Fire drills are carried out regularly
Personal Protective Equipment at Work Regulations 1992
Key guidelines:
• Appropriate protective clothing and equipment should be provided and
worn.
• All clothing should be well-fitted.
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Workplace (Health, Safety and Welfare) Regulations 1992

• Work stations are at correct height (e.g. couch)
• Adequate breaks when using equipment, e.g. computer screens
• Appropriate lighting, ventilation and heating
Data Protection Act 2018 –the UK implementation of the General Data

Protection Regulation (GDPR)
This protects the client's right to confidentiality.
• Information should not be disclosed to any third party

• Information sharing is only allowed for legal reasons or for client protection
(e.g. referral)
• Gain consent prior to disclosing information
• Store all records securely
• Dispose of records appropriately
• Maintain records for appropriate time frame
• All data and records should be:
• Used fairly and lawfully
• Used for limited, specifically stated purposes
• Used in a way that is adequate, relevant and not excessive
• Accurate
• Kept for no longer than is absolutely necessary
• Handled according to people's data protection rights
• Kept safe and secure
• Not transferred outside the UK without adequate protection
Management of Health and Safety at Work Regulations 1999
Key guidelines:
• Appoint an appropriate person to conduct risk assessment of all working
areas
• Risk assess all areas to identify potential hazards
• Manage risks - eliminate where possible and if risks cannot be eliminated,
they must be reduced, isolated, controlled and/or protective clothing worn
• Provide staff training on risk assessment
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Health and Safety at work Act 1974
The Health and Safety at Work Act (1974) was the main piece of legislation
offering directives to maintain health and safety in England, Scotland and Wales.
Key guidelines:
• All employers and employees are responsible for the health and safety of
self, colleagues, clients and anyone else who uses a specific environment,
including external visitors
• Employers should register with HSE and display a health and safety poster,
naming the responsible person for health and safety
• There should be policies and procedures for dealing with health and safety
and all staff should be inducted to these
• There should be an appointed first aider
• All staff should be appropriately qualified and hold relevant insurances
• There should be hygienic toilets and washing facilities, clean drinking water
and appropriate rest and eating facilities.
• The work area should have appropriate lighting and ventilation
• Appropriate training should be provided for staff in all aspects of relevant
health and safety including: fire drills, manual handling, handling
chemicals, purpose of fire extinguishers and emergency exits
• All health and safety policies should be reviewed and updated regularly
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Health & Safety
It is important to be aware of current health and safety legislation as there are legal
requirements you must follow; you have a duty of care to your clients and a responsibility to
manage you own and your client’s health and safety. There will be different levels of
responsibility depending on whether you are working in the capacity of an employee or as
an employer or self-employed worker.
Employer’s responsibilities:
• Provide policies and procedures.
• Provide induction and training.
• Provide protective equipment.
• Risk assessment.
• Insurance.
Employee’s responsibilities:
• Take responsibility for own health and safety.
• Follow organisation procedures.
• Dynamic assessment of risk to self and others.
Main influences on health & safety.
• Environmental factors – the conditions in which people work, e.g., the working
temperature, ventilation and noise.
• Occupational factors – people may be at risk from certain illnesses due to the
services or treatments they offer, e.g., allergies to products used.
• Human factors – people contributing to accidents due to poor behaviour,
carelessness, error or haste, e.g., forgetting to clear a spillage of oil from the floor.
Health and safety procedures should not be seen as box

check exercises and should instead form part of day-to-day
practice to ensure the smooth running of a safe practice for
all involved.
The most important part of health and safety is being
aware of, and minimising and/or managing risks.
Particularly if you are self-employed or an employer, it is important to be aware of the

following legislations relating to health, well-being & safety. The Health and Safety at Work
etc. Act (1974) is the primary legislation which enables a series of regulations surrounding
practices to maintain health and safety in the workplace. The Act sets out the general duties
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which employers have towards employees and members of the public, and employees have
to themselves and to each other. The regulations are essentially rules to which employers
need to adhere by maintaining good working practices and following approved codes of
practice.
What the law requires is what good management and common sense would
lead employers to do anyway: that is, to look at what the risks are and take
sensible measures to tackle them.
Health & Safety in Practice

The Institute of Occupational Safety and Health (IOSH) offers some straightforward guidance
for complementary therapists around health and safety. In summary:
In the UK, the law applies to all businesses, large or small. If you’re self-employed or an
employer then you are responsible for the health and safety of your business. The law is
there to make sure you have a safe working environment and cut down the risk of you, your
staff (if you have any) or clients getting ill or injured.
So, by law you must...
…get some help with your health and safety duties

As an employer you must appoint someone who knows about health and safety. This may
need to be an external advisor.
…write and regularly review a health and safety policy for your business
Your policy doesn’t have to take you long to write, or be lengthy or complicated. The policy
should describe how you’ll manage health and safety and should clearly state who does
what, when and how. It is only required to be written down if you have 5 or more staff.
…manage the risk in your business
You must consider (assess) and manage any risks where you work or connected with what
you do. This is a straightforward process. This is simply thinking about what you do in your
business that could harm people and what you’re going to do to try to stop it happening.
…talk to your employees
If you employ anyone, you need to consult them on health and safety.
…give training and information
If you have staff, they need to know how to work safely and without risking their health. You
must give clear instructions, information and training. Don’t forget to include temporary
workers.
…have the right facilities
You need to provide: - toilet and washing facilities - drinking water - somewhere to store
clothing and to change if your staff wear a uniform - somewhere to rest and eat meals. If
you’re a mobile therapist, you might need to consider alternatives.
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You need to make sure that where you work is healthy, and that you have: - good
ventilation – fresh, clean air drawn from outside or a ventilation system - a comfortable
working temperature – usually at least 16 degrees C - lighting suitable for the work being
carried out - enough space, seating and so on - a clean environment with bins appropriate
for the type/s of waste.
…plan for first aid, accidents and ill health
You have to organise first aid arrangements where you work. If you’re self-employed, with
no staff, you need to have a first aid kit. By law, you must report and keep a record of
certain accidents, incidents and illness.
…display the health and safety law poster
If you employ anyone, you must either display the HSE’s law poster, or give each member of
staff the pocket card version. The poster outlines UK health and safety law and includes a
simple list that tells employers what they and their employees need to do.
…get insurance for your business
If you have employees you’ll probably need employers’ liability insurance. There may be
other types of insurance you need, such as public liability, or ‘driving for business’ cover if
you’re a mobile therapist.
…keep your business up to date
Keeping up with news and developments in your sector will help you keep your health and
safety policy and risk assessments up to date.
Some examples of things to consider:

▪ How you use and store essential or carrier oils
▪ How you minimize likelihood of allergic reactions
▪ How you manage risk of infections being passed between you and your clients
▪ How you can minimize the impact of giving regular manual therapies on your body
▪ Procedures for lifting or moving heavy equipment
▪ How you keep yourself safe when lone working
▪ How you manage risk of fire where you work
There are many other areas of your practice that you will need to consider but they
certainly do not need to be complicated processes.
Risk Assessment
Risk management is a step-by-step process for controlling health and safety risks caused by
hazards in the workplace.
You can do it yourself or appoint a competent person to help you.
The law does not expect you to remove all risks, but it does expect you to control them.
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In your line of work, depending on the type of therapy you offer, you will probably look at
things like using and storing essential oils or beauty products, contact with the body and
skin, aches and pains, lifting and carrying heavy equipment.
When thinking about your risk assessment, remember:

■ a hazard is anything that may cause harm, such as chemicals, electricity,
working from ladders, an open drawer etc;
■ the risk is the chance, high or low, that somebody could be harmed by
these hazards, together with an indication of how serious the harm could be.
Advice from the Health & Safety Executive (HSE) suggests the following when assessing risk.
1. Identify hazards
Look around your workplace and think about what may cause harm (these are called
hazards). Think about:
▪ how people work and how equipment is used
▪ what chemicals and substances are used
▪ what safe or unsafe work practices exist
▪ the general state of your premises
Think about hazards to health, such as manual handling, use of chemicals and causes of
work-related stress.
2. Assess the risks
Once you have identified the hazards, decide how likely it is that someone could be harmed
and how serious it could be. This is assessing the level of risk.
Decide:
▪ who might be harmed and how
▪ what you're already doing to control the risks
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▪ what further action you need to take to control the risks
▪ who needs to carry out the action
▪ when the action is needed by
For each hazard, think about how employees, contractors, visitors or members of the public
might be harmed.
3. Decide on precautions
Look at what you're already doing, and the controls you already have in place.
Ask yourself:
▪ Can I get rid of the hazard altogether?
▪ If not, how can I control the risks so that harm is unlikely?
If you need further controls, consider:

▪ redesigning the task/s
▪ replacing the materials, equipment or process
▪ organising your work to reduce exposure to the hazard
▪ identifying and implementing practical measures needed to work safely
▪ providing personal protective equipment and making sure it is worn
Put the controls you have identified in place. You're not expected to eliminate all risks but
you need to do everything 'reasonably practicable' to protect people from harm. This means
balancing the level of risk against the measures needed to control the real risk in terms of
money, time or trouble.
4. Record findings and implement them
If you employ 5 or more people, you must record your significant findings, including.
▪ the hazards (things that may cause harm)
▪ who might be harmed and how
▪ what you are doing to control the risks
Do not rely purely on paperwork as your main priority should be to control the risks in
practice – there is no use having a risk assessment on file if the measures are not being
implemented!.
It could be good practice to record risk assessments even if you do not have 5 employees.
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5. Review assessment and update if necessary
You must review the controls you have put in place to make sure they are working. You
should also review them if:
▪ they may no longer be effective
▪ there are changes in the workplace that could lead to new risks such as changes to:
▪ staff
▪ a process
▪ the substances or equipment used
Also consider a review if your workers have spotted any problems or there have been any
accidents or near misses.
Update your risk assessment record with any changes you make.
For example:
The likelihood of a client with a contra-indication experiencing a negative reaction

during or after massage may receive a score of 3-5. The severity of the reaction may
score 4-5. The total risk rating would be between l2 and 25 making treatment HIGH
RISK. The action would be to eliminate the risk and signpost them to their GP.
If risks are identified apply ERIC.
ELIMINATE REDUCE ISOLATE CONTROL
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Areas to consider
Electrical safety
Electricity can kill or severely injure people and cause damage to property. However, you
can take simple precautions when working with or near electricity and electrical equipment
to significantly reduce the risk of injury to you, your workers and others around you. This
section provides a summary of those precautions.
Fire safety
Most fires are preventable, and those responsible for workplaces and other buildings to
which the public have access can avoid them by taking responsibility for and adopting the
right behaviours and procedures. This section covers general advice on fire safety and also
provides guidance on substances that cause fire and explosion.
Harmful substances
Many materials or substances used or created at work could harm your health. These
substances could be dusts, gases or fumes that you breathe in, or liquids, gels or powders
that come into contact with your eyes or skin.
Manual handling
Manual handling causes over a third of all workplace injuries. These include work-related
musculoskeletal disorders (MSDs) such as pain and injuries to arms, legs and joints, and
repetitive strain injuries of various sorts.
Personal protective equipment.
Employers have duties concerning the provision and use of personal protective equipment
(PPE) at work. PPE is equipment that will protect the user against health or safety risks at
work.
Slips and trips
Most slips occur when floors become wet or contaminated and many trips are due to poor
housekeeping. The solutions are often simple and cost-effective and a basic assessment of
the risks should help to identify any slip or trip hazards in your workplace.
Tumble drying towels has the potential to be a fire hazard.
Did you Oil stains on towels that are not successfully cleaned can
spontaneously combust following tumble drying as the heat
know? can cause the oils to set alight. This is a rare occurrence.
To minimise the risk, wash towels on a high temperature
wash using biological detergent (these contain enzymes
which are more successful at breaking down fatty acids).
Allow the drying cycle to finish completely then remove
towels from the tumble drier promptly. Shake out towels and
fold. Avoid stoving in big piles or bundles.
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Chemical Hazard Symbols
Some products have hazard symbols on their package. Be aware of what they mean.
Environmental Hazard
Indicates substances that are toxic to aquatic organisms, or may
cause long lasting environmental effects. They should be disposed
of responsibly.
Acutely Toxic
Indicates life-threatening effects, in some cases even after limited
exposure. Any form of iingestion and skin contact should be
avoided.
Corrosive
May cause burns to skin and damage to eyes. May also corrode
metals. Avoid skin & eye contact and do not breathe vapours.
Flammable
Flammable when exposed to heat, fire or sparks, or give off
flammable gases when reacting with water. Ignition sources should
be avoided.
Moderate Hazard
May irritate the skin, or exhibit minor toxicity. The chemical should
be kept away from the skin and the eyes as a precaution.
Health Hazard
Short or long term exposure could cause serious long term health
effects. Skin contact and ingestion of this chemical should be
avoided.
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Hygiene
Sterilization and Disinfecting
Massage typically does not have tools which would be disinfected in a steriliser. However, it
is important to know good practice around keeping your equipment clean and disinfecting
between clients.
Sterilization: This is the complete destruction or removal of living organisms on an object.
Micro-organisms may be destroyed by heat, chemical disinfectants and ultraviolet radiation.
All tools must, however, be cleaned to remove grease before disinfection is to take place.
Disinfection: This is the destruction of micro-organisms, but not usually bacterial spores,
reducing the number of microorganisms to a level, which will not be harmful to health. In
most salons, ‘barbicide’ is a recognized name as a germicide and disinfectant liquid in which
tools can be stored. Surgical spirit can also be used.
Tools for cleaning
Antiseptic: Is a substance that inhibits the growth of bacteria but not kill the bacteria.
Autoclave: This is like a pressure cooker, with the water contained inside it reaches
temperatures of 121 – 134 C. This is the most effective method for the sterilization of tools.
Glass bead sterilizer: Small glass beads are retained in a beaker and heated to a
temperature of 190C. Tools are placed in these beads for 10 minutes. A disadvantage of
glass bead sterilizer is that it cannot hold large items.
UV Sterilizer: UV light will only be effective on surfaces that are exposed to the UV light.
Tools will therefore need turning during the process to ensure that all surfaces are
thoroughly sterilized. UV sterilization is not suitable for brushes.
Pathogens
A pathogen is any organism that can produce disease. A pathogen may also be referred to as
an infectious agent, or simply a germ. Pathogens can make us sick, but when healthy, our
bodies are able to defend against pathogens and the illnesses they cause.
Bacteria: A single cell organism without a nucleus, which produces a toxin.
Fungus: This is a low form of vegetable life, which includes mushrooms and moulds. Some
varieties cause disease, such as ringworm. A fungi stat will inhibit growth of any fungus
while a fungicide will kill fungus outright.
Virus: A virus is a sub microscopic infectious agent that
replicates only inside the living cells of an organism. Viruses
can be classed as pathogenic or non-pathogenic.
Parasites: Organisms which live in or on a host and feed
from them.
The best way to protect against pathogens is to wash
hands often and keep areas clean
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For a health and safety for business overview visit: https://www.hse.gov.uk/simple-health-
safety/index.htm
For the IOSH guide to Health & Safety as a Complementary and Beauty Therapist visit:
https://www.iosh.co.uk/~/media/Documents/Books%20and%20resources/Safe%20start%20up/safe
_start_up-therapists.ashx
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Lesson 3: Looking after yourself
▪ Describe how you can keep yourself safe and healthy as a

therapist including posture, working positions, attitude and
exercise;
▪ Understand what lone working means and how to manage
working alone;
▪ Safeguarding Legislation
How can massage therapists protect and take care of themselves?

Massage is a very physical treatment. It can take a lot out of the therapist giving it.
The effects of the treatment depend on the physical energy of the therapist performing it. If
the energy is depleted by health problems or limited by incorrect posture, then the
treatment will be less effective.
Any therapist continuing to work without paying attention to correct posture will cause
damage to their own body, both in the short and long term.
To protect themselves, massage therapists should pay
attention to the following 4 areas:
• Posture
• Working positions
• Attitude
• Exercise
Each one of these factors contributes to the positive effects of treatments and
prevents the therapist from harming themselves.
Posture
Good posture is necessary both for your own health and well-being and to maintain a
quality and sustainable practice.
When consulting and working on the client the therapist should avoid:
• Tension in arms, neck, and shoulders
• Stiff, rigid legs and locked knees
• Stiff, inflexible wrists and hands
• Uneven distribution of weight in the legs
• Slouching or crossing the legs
• Repeating the same movements too often: varying the routines helps prevent
repetitive strain injuries.
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All the above can cause neck and back problems, muscle strain and repetitive strain injuries.
Not only are they damaging, but they also affect the therapist’s attitude, give a poor
impression, and prevent the most effective treatment.
A balanced upright posture has many advantages:
• Enables the body to withstand fatigue,
• Eases nervous tension and increases mental alertness,
• Increases physical stress tolerance,
• Body becomes less susceptible to infections and illness and less prone to injury,
• Increases physical confidence and emotional balance.
Receiving body massage can help improve posture as it:

• Helps lengthen compressed joints,
• Helps to improve nutrients to soft tissues and joints,
• Helps loosen stiff joints and encourages movement where it is lacking,
• Helps maintain full joint mobility and good muscle tone.
Maintain correct posture during massage treatments:

• Keep the back straight but not rigid,
• Keep wrists and forearms as straight as possible without locking them,
• Keep legs slightly bent,
• Keep shoulders relaxed,
• It is common tendency to tense the shoulders, holding them close to the ears –
practice rolling your shoulders forward and backward before each treatment,
• Move around the client instead of overreaching and risking muscle damage,
• Distribute the weight of the body evenly between both legs - many of us tend to rest
on one leg, overworking it and weakening the other,
• Take regular breaks between (not during!) treatments,
• Invest in a height adjustable chair or couch for clients,
• Be aware of your own body, where tension is held and what causes strain.
Awareness of one’s body limits will help prevent overstretching it.
Remember – it is often the tiniest movements which cause the most damage.
Good posture enables the therapist to concentrate on the massage
without worrying whether they will be able to perform the
movements and limits the likelihood of acute or chronic injury.
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Working Positions
Working positions are designed to protect the working
therapist from muscle or joint strain as well as allowing
maximum mobility and pressure for the treatment
The positions below are the recommended main positions for
a full body massage.
Striding position
Stand with your body at an angle to the table, feet positioned
as if striding forward in a lunge position. Maintain flexible
knees and shift your body weight from the back leg into the Striding Position
front leg to get momentum to your stroke.

This position is used for long strokes, such as effleurage, along
the length of the body, particularly across the back and the
legs.
Side standing position
Feet should be wide apart and positioned at 45 degrees from
the body. Keep knees soft and hips forward, with your rear
tucked under. Forearms should be at right angles to the body
and wrists flexible. Keep the neck straight and glance down at
your client without bending your neck.
Side Standing Position
This position is used for short strokes such as kneading,
wringing and percussion, rather than effleurage, when work is across the muscles or in a
local area.
Attitude
Have you ever noticed that when you are in a good mood and you meet someone in a bad
or negative mood, you often leave feeling less positive? This is because other people’s
moods and attitudes affect us. When giving a treatment a therapist’s mood & attitude will
affect their client.
A tense therapist will make the client tense.

A rushed therapist will make the client feel rushed.
For a massage to have the desired effect for the client, whether it’s intended to be relaxing
or energizing, the therapist will need to bring the right attitude to the treatment room.
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In general, the therapist should feel centered and focused, secure and calm and able to
concentrate on using their own physical or mental energy to work on and improve the
physical or mental energy of the clients. Always begin a massage in a positive and caring
frame of mind. Take time to relax and center yourself before you start the treatment. Once
the treatment has started, encourage your client to relax by not engaging in too much
conversation, merely reply to any questions and let them know you are listening.
To give a treatment you need to be quiet and calm. Put aside at least 10 minutes before
each new client to free yourself from tension and mental preoccupation, so you can relax
into the rhythm of the massage, which will enhance the treatment for your client and is less
tiring for you.
Try these simple techniques to focus and prepare yourself:

Close your eyes and sit quietly for a few minutes.
Let go of any thoughts that may be worrying you or are
cluttering your mind.
Concentrate on your breathing. Imagine all unnecessary tension
flowing out of you each time you exhale.
Exercise and breathing
A massage therapist will need to take regular exercise to have the

physical fitness and stamina to carry out the treatments. Exercise is one
of the best ways to relax after work, to prevent the build-up of tension and
stiffness from working in similar standing positions all day. Hands and wrist should
also be exercised on a regular basis to keep them supple and flexible.
Breathing exercise can help with relaxation both during and between
treatments. Throughout the massage the therapist should be aware of their breathing and
that of the client. The therapist should encourage the clients to breathe deeply and evenly
and should make sure their own breathing is calm, regular and matches the client’s pace.
This will enable both parties to relax and concentrate on the treatment. Yoga, meditation
and tʼai chi are all exercises which include breathing techniques, while at the same time
strengthening the body and mind. (Tucker, 2016)
Good news!
Therapists should try to receive regular massage
treatment themselves.
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Lone Working
Lone working is defined by the HSE (Health & Safety Executive) as “those who work by
themselves without close or direct supervision”. It includes working outside of normal office
hours, working from home, working in other people’s homes and those who travel as part of
their job. As a massage therapist you are likely to be lone working most of your working day.
As an employee you should ask your employer for a copy of their Lone Working Policy. As a
self-employed individual you should establish a lone working policy and share your process
with someone close to you – e.g., someone you live with or have regular contact with.
If you are concerned about your safety due to lone working, perhaps if you also live alone,
you could consider utilising a lone worker safety monitoring service. You can use such apps
on your phone to check in and out before and after each client visit, for example.
Chaperones
A chaperone is someone who accompanies someone else to an appointment. Guidelines for
best practice when working with children and vulnerable adults indicate not to be alone at
any point. The Safeguarding Vulnerable Groups Act (2006) protects the welfare of children
and vulnerable adults.
It aims to ensure their safety, protect them against maltreatment, remove any risk of harm,
neglect or abuse. Sometimes, harm can be experienced by a vulnerable person simply
through misunderstandings. Having a chaperone to help with communication can be a
useful tool to protect the person against harm. When working with a child or vulnerable
adult it is equally important to protect yourself in case of any allegations. A chaperone can
be useful to protect against this.
Definitions:
Child Most protection agencies in the UK refer to children as any person under 18
years old.
Vulnerable Any person “aged 18 years or over, in receipt of or in need of community
adult care services by reason of mental or other disability, age or illness and who is
or may be unable to take care of him or herself, or unable to protect him or
herself against significant harm or exploitation.” (Dof Health, 2000)
Chaperones can:
• Provide support to child or vulnerable person.

• Assist with explanation of
• providing a medical background for the consultation
• the proposed treatment
• informed consent (or in some cases providing it on behalf of the vulnerable person)
• Offer protection for all parties, e.g., allegations.
• Provide reassurance to client.
• Alleviate anxiety the client may feel, e.g., if the therapist is not known to them.
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Key guidelines :
• Protect the interests of clients who are minors or clients who are unable to
give voluntary and informed consent by
• securing permission from an appropriate third party or guardian
• Never work with children or adults without a chaperone
• Provide a safeguarding policy and procedures
• Ensure staff are trained to identify and deal with issues relating to
safeguarding, including suspected abuse or
• allegations of abuse and how to contact the statutory agencies
• Maintain appropriate Disclosure Barring Service (DBS) records for all staff
working with children or vulnerable adults
• Appoint a named person responsible for managing safeguarding
• Manage records and information sharing appropriately
Children are defined by most protection agencies in the UK as:
'Any person under the age 18' (NSPCC. 2014)
In comparison to adults, all children are vulnerable. Some children are more
critically vulnerable than others. This would include children who:
• Have been orphaned by the death of one or both parents.
• Have been abandoned by parents
• Are living in extreme poverty.
• Are living with a disability.
• Are, or have been affected by armed conflicts.
• Have been abused by parents or their carers.
• Are malnourished due to extreme poverty.
• HIV-positive
The standards relevant to the massage profession

Professional standards and organisations
There are currently a number of professional bodies that provide massage therapists
with information regarding standards, codes of practice and regulatory
requirements for the sector.
The purpose of regulation.
The main roles of these regulatory bodies is to:

• Help maintain high standards of practice, safety and protection
• Maintain a national register of professional members
• Ensure continued professional development of practitioners
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The main organisations and the service they provide to the massage therapy
industry is provided in the table.
Organization Roles and responsibilities

Complementary CHNC is a voluntary regulator for complementary therapists
and Natural including sports massage.
Healthcare It is a government supported organisation, which ensures
Council (CNHC) standards of practitioners is safe and industry standards are
met. It manages a national register of therapists who can use its
quality mark when promoting their services. This quality mark
potentially increases public confidence in selecting a therapist.
.The therapist can promote the services it offers on the CHNC
web site. CHNC have links with employers, who often request
evidence of membership as a form of quality assurance. Some
healthcare insurance plans will work with members of the
CNHC. The cost of membership is currently in the region of £100
per year.
Federation of FHT is a non-profit making organisation.

Holistic It is a professional association representing many holistic
Therapists therapies. It offers professional status and recognition and is
(FHT) useful for providing insurance for therapists. It has a register of
therapists but this is not government recognised. FHT provides
CPD courses and also offers a support network for therapists,
which is useful for self-employed therapists who work
independently. It has a shop from which it supplies discounted
products and can also supply marketing material, which is also
useful for self-employed therapists. One disadvantage is that
sports massage may not be seen as a holistic therapy, so
prospective clients may not search this website.
General Council GCMT is the governing body for massage and soft tissue
for Massage therapies that form all bodyworks and soft tissue techniques in
Therapies the UK. It is a non-profit making body.
(GCMT) Council members include awarding organisations and
professional organisations such as SMA, VTCT and other
awarding organisations. GCMT brings together many
stakeholders within the industry to help define and influence
educational standards. It acts as a lobbying and pressure group
in the areas of education, regulation, insurance and
employment representing all members. It also initiates research
into soft tissue therapy, keeping the industry current.
Sports Massage The SMA is a non-profit making organisation.
Association It is a professional organisation specifically for soft tissue
(SMA) therapy. It offers professional status and recognition and is
useful for providing insurance for therapists. It also has a
register of therapists but this is not government recognised.
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The SMA maintains minimum standards for sports massage
therapists, which keeps the quality of treatments high and
prevents under-qualified people working in the industry. It has
contacts with high level sports organisers such as the Olympic
committee and the Commonwealth Games committee which
ensure the representation of therapists at these events.
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Lesson 4: Preparing for Massage
- Describe the requirements for preparing self, client, and

work area for Indian head massage treatment, in
accordance with working practice requirements;
- Identify key requirements to professionalism;
- Describe how a therapist should present for treatment.
In addition to the basic health and safety considerations, there are several other
considerations to ensure that yourself, your work area and ultimately your client are
prepared for massage. Many elements relating to this learning objective will be reiterated
throughout the course and during the practical aspect of your training.
Different ways of working as a complementary therapist will have different requirements for
preparing your practice. You may be employed at a clinic where nearly all considerations are
managed for you and you simply ensure that you, personally, are prepared to deliver a
treatment. You may rent a treatment room and need to ensure that you have a process in
place to ensure that you take all the resources you require with you each time, making sure
not to forget any essentials. You may be working from home and be considering converting
a space in your house to a relaxing treatment room. Maybe you will work as a mobile
therapist and have additional considerations around transportation and manual handling.
The next few lessons aim to get you thinking about your practice and consider both the legal
and practical considerations.
COVID-19: Be sure to check local / national rules in your area

to ensure that you are permitted to carry out massage.
Business Requirements in preparation for massage therapy.

Whilst the massage therapy industry is unregulated, there are certain requirements that you
should adhere to in order to practice legally and to make sure that you are following best
practice.
Insurance
You should have professional indemnity and/or public liability insurance in place when you
start practicing massage. You may also wish to have stock/equipment cover and/or buildings
and contents cover.
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Regulatory Bodies
The industry is governed by voluntary regulation. This means you can choose to apply for
membership to regulatory bodies. This helps you to be recognised as a professional
therapist. The two main regulators for complementary therapy are CNHC and GRCCT.
Professional Association Membership
Massage therapists may be accredited by the Federation of Holistic Therapists (FHT), or the
Complementary and Natural Healthcare Council (CNHC). Registering as an accredited
therapist gives your clients added reassurance that they are in safe hands. They also provide
resources to help you ensure you are delivering a best practice service, such as the FHT
Code of Conduct. Another benefit is that they typically provide insurance too.
Special Licence
Most local authorities in the UK require you to have a ‘special licence’ to provide massage
services from a home location. Check the requirements with your local council.
The Equality Act 2010
This legally protects people from discrimination in society. It is against the law to
discriminate against anyone because of their age, gender identity, marriage status, being
pregnant, disability, race, religion or belief, sex, sexual orientation. Members of the public
are protected from discrimination as a consumer, which covers paying for goods or services.
This means your clients are protected from discrimination, by this law, and you must act
within and make reasonable adjustments to meet this law. An example of an exemption is
that ‘a massage service [can] be provided to women only by a female massage therapist
with her own business operating in her clients’ homes because she would feel
uncomfortable massaging men in that environment’. Another example would be refusing
treatment to someone who is pregnant as it is contraindicated in the first trimester.
Professionalism
Being professional includes:
• Preparing yourself and your surroundings

• Being punctual
• Providing a professional service
• Be aware of contra-indications and danger signals
• Following-the guidelines / ethical code of your professional body
• Keeping up to date with:
o Legal legislations / By-laws / Parliamentary acts related to your profession
o new developments within your profession / therapies
• Being a reflective and ethical therapist
• Protecting your client’s confidentiality and modesty
• Maintaining a good working relationship with the medical profession and / or other
therapists
• Obtaining written consent for treatment - where necessary:
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o Medical - if client is under medical supervision
o Parental / guardian - when treating children under the age of 16 years
• Knowing when to refer a client - recognizing your limits
• Referring clients on to other professionals when necessary
• Recommending only relevant and appropriate
treatments for the client
• Not offering advice or services outside your
area in which you are qualified (certainly not
attempting to diagnose any ailment)
• Not making false claims for the therapy you
offer
• Not discussing other therapists or
salons/clinics
• Communicating with clients:
o Introduction / consultation methods
o Listening skills
o Body language
• Dealing with negative feedback positively
• Managing client's expectations
Preparing Yourself – Therapist Presentation

The previous lesson considered elements of preparing yourself for giving massage
treatments in terms of your attitude and physical wellbeing, but it is important to also
consider the presentation of you, the therapist, when preparing to offer body massage.
Therapists should wear appropriate attire including comfortable and covered footwear.
Massage therapy uniforms are typically single coloured, normally white, grey, black or blue
but can range in colour. Clothing for massage should be comfortable and breathable, not
too tight, but not so loose that it risks being too revealing when bending over. You should
have more than one uniform so that they can be washed regularly to maintain hygiene
standards.
Therapists should wear no jewellery when giving treatments other than a simple band ring
(such as a single wedding band) and simple stud earring/s. Fingernails should be short,
clean, and unvarnished. Hair should be worn away from the face/collar.
Task: Preparing yourself
Make a list of anything you think you might need to

research further. Perhaps you want to consider
purchasing some branded uniforms. Do some research.
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Personal and clinical standards
To provide a professional service to clients, the therapist must ensure that

appropriate personal and clinical standards are maintained. The massage therapist
should seek to improve continually and develop their practice and aim to achieve
standards of excellence.
The baseline standards for personal and clinical practice are listed in the table.
Personal standards Clinical standards
• Personal hygiene • Provide treatments with

• Dress and appearance - clean and professional competence
smart, e.g. uniform • Gain client informed
• Attitude consent prior to any
• Personal conduct assessment or treatment
• Punctuality and reliability • Treat all clients with respect and
• Integrity • dignity, e.g. draping
• Respect • Hygiene of all equipment and
• Core conditions - environment
empathy, positive • Health and safety maintained
regard and • Risks assessed and managed
congruence • Referral of clients, when
• Positive communication - verbal, appropriate
non-verbal and written, • Appropriate record keeping
• including active listening, building • Insurance
rapport and trust • Adherence to guidance
• Maintain continuing professional provided By professional
development organisations
• Work within scope of practice
• Respect personal and professional
boundaries
• Respect other professionals and
colleagues
• Respect the history and traditions of
the sector
Page 42
References
https://www.haringey.gov.uk/business/licensing-and-regulations/licensing/z-
licences/massage-and-special-treatments/massage-and-special-treatment-standard-
conditions
https://www.fht.org.uk/code-of-conduct-and-professional-practice
https://www.simplybusiness.co.uk/downloads/how-to-become-a-massage-therapist.pdf
https://www.legislation.gov.uk/ukpga/2010/15/notes/division/3
Page 43
Lesson 5: Massage Equipment
- Consider equipment required for giving body massage

treatments;
- Describe the environmental conditions suitable for body
massage treatment.
Equipment for massage

Massage is practiced on a one-to-one basis; it is important to inspire trust, in your
ability as a practitioner, in your client. Your professionalism will be reflected in the way
you prepare your treatment.
The room should be clean, warm, welcoming, private, quiet, and well ventilated with
subdued lighting.
All equipment should be clean, ready for use and in easy reach. A simple therapist’s
trolley can help keep those essentials to hand.
Equipment you may need:

o Massage couch
o Face hole ring and small head pillow (folded hand towels can be used instead)
o Fabric couch cover
o Towels (2 extra-large bath sheets, 2 large bath towels & 4 hand towels) which
ideally should be dark, matching colours
o Stool for giving face treatments
o Light blanket
o Plastic oil bottles with lids
o Oil bottle holster
o Therapist trolley
o Waste bin
o Small bowl for client’s jewelry
o Bottled water and glass
o Dressing gown and slippers for client (multiple to accommodate one per client
between laundry)
o Relaxing and soft music - Can be a great contribution to a treatment for both giver
and receiver, enhancing the atmosphere and supporting your client's relaxation
o Screen - For client to undress if practitioner cannot leave the room
o Chair for client consultation
o Washing machine
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Consumables:
o Couch paper roll (if used) – look out for the correct width!
o Massage medium
o Box of facial tissues
o Antiseptic or anti-bacterial wipes
o First Aid Box
o A candle or essential oil burner
o Cleaning products
o Face / make-up wipes for client use
o Sanitary products / toiletries available in the bathroom for client use
o Laundry detergent
Consider our planet!

You might want to think about how you could opt for environmentally
friendly, sustainable options when purchasing equipment.
Can you buy second-hand? Are there reusable options to replace
disposable ones without compromising hygiene? How could you
identify ethical suppliers?
Creating a professional massage environment.

It is important to prepare the massage
environment that you provide for your
clients to ensure that the experience and
treatment is not only as relaxing and
comforting and professional for them as
possible, but also safe. This is essential, not
only for the well-being and outcome for the
client but, equally, for your business so that
clients are more likely to return and to refer
others to your practice.
You need to have sufficient space in which
to provide your massage treatment. A
typical treatment room ranges from 8m2 –
16m2. You should have at least 1m each
side of your table for you to be able to
practice from. Small rooms can feel
cramped, but large rooms will cost more to
heat and clean etc.
Environmental aspects that you should
consider include the heating and lighting
and ventilation, privacy, noise levels both
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externally and of any music that you provide. You will want to consider the general decor
and quality and appearance of your equipment. It is important to consider the ease of
maintaining the general hygiene of the area and management of waste.
These considerations need to be balanced with one another. For example, you may wish to
include ornaments or decorations, such as anatomy models, in your treatment room to add
to the ambience or demonstrate your ethos, but it is worth recognising that these items
may add to the frequency and duration of your cleaning practice. On the other hand, a
practice room without any décor additions may appear sterile and uninviting and not put
the client at ease.
COVID-19: Remember that in current times with the national

coronavirus pandemic, additional precautions should be
incorporated into your practice. For example, you should make
efforts to increase the ventilation in your treatment area, which
may lead to a need to have additional heating options.
Be sure to keep up to date with guidelines for working safely
and make necessary adjustments.
The space you use may be a multipurpose space, such as your living room or home-office
space. Consider how you might be able to minimise the impact of having additional,
unrelated equipment or furniture in the space to create a treatment room which is not too
overloaded.
Some of the following considerations will be covered in requirements by a special licence.
Be sure to cover all conditions of your licence as a minimum.
Considerations
Access and How will your clients find you? Is the approach clean, tidy and well-lit? How
privacy accessible is your treatment room? Is there step-free access? This is not a
requirement but is worth considering and making clear to clients.
How and where will you greet clients? Is there a reception space? Is the
treatment room private? Will clients have a separate space to get undressed, or
will you leave the room? If treating from your home, what elements of your
private life will be accessible to the client if you need to walk through other
spaces?
Décor Consider warm but neutral décor in your massage space to not overload senses
and provide an inviting space. Plants can be a great addition to your space –
consider low maintenance, air-purifying indoor plants. Depending on your
marketing approach you may include decorations that complement your
approach, for example anatomy models or diagrams. For some inspiration, visit
this blog post.
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Equipment & As well as a massage couch, you may need a seat for your client for removing
Furniture their shoes, or during your consultation. You might want a stool for delivering
facial massage, and a trolley to store supplies required during treatment.
Massage equipment is covered in the next lesson.
Facilities Are there bathroom facilities nearby for your client to access? Is there a sink
space for you to wash your hands? What laundry facilities available for cleaning
your linens? Where will you get drinking water from?
Heating Your treatment space (and changing area / bathroom) should be neither too hot
nor too cold. How will you cool or heat the area at different times during the
year? Fan heaters/coolers can be effective but can be noisy. Storage heaters
take a while to heat up but heat efficiently. Air conditioning can be expensive to
install and run. Could you warm your towels in preparation for your client’s use?
You could invest in a massage table heating pad – like an electric blanket for
your massage couch – to keep clients cosy during their massage.
Lighting Does your treatment room have natural light? You should be able to control the
light in the room so that, even on a bright day, you can darken the room
sufficiently for your client’s comfort and relaxation. Use soft lighting that is not
directly over the massage table. Dimmer switches are great to be able to control
the ambience of the lighting and indicate the beginning and end of the
treatment time. Think about using energy efficient bulbs to reduce your energy
bills!
Scent Be mindful of the smells in your treatment space. Any noticeable scents may add
to or detract from the experience. Candles, incense, or oil burners/diffusers can
be used, but should be subtle and not overbearing. Remember to consider safety
aspects when using candles or electrical equipment. Consider asking your client
in an initial consultation if they have a preference. Be conscious, too, of your
own scent. Avoid overpowering perfumes, body odor and bad breath.
Sound
Try to minimize any external noise during the consultation and treatment.
Also consider the tone and level of your own voice to aid the relaxing
environment whilst still being clear and easily understood by your client.
Background music should be at a level that adds to the atmosphere rather
than distracts from the overall experience. A suggestion is that
background music should be approximately 40 decibels – but you’re not
expected to have the means to measure that! Be aware that you may
need a license to play music for your treatments. What would you do if
there are scheduled, noisy, road works right outside your treatment
room?
Storage What storage do you have available for your client’s belongings? Do you
have somewhere to hang outdoor coats? What about wet umbrellas?
Where will clients put their clothes and valuables when they change? A
laundry basket with an additional container for small items such as
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jewellery is a great option that can be stored under the massage couch
during treatment.
What storage do you require for your own equipment and massage
resources? Do you want storage that is open, such as shelves, or closed
behind cupboard doors? How will you store items you need to be
accessible during treatments?
Ventilation There must be suitable and sufficient means of natural or mechanical

ventilation in the treatment room, and wherever practicable this should
be direct to the external air. How will you ensure your space is well-
ventilated?
Waste & You will need access to cleaning supplies to keep your massage space
hygiene hygienic for the protection of both you and your client. Anti-bacterial
surface sprays are great but remember anti-bacterial products may not be
effective against viruses, such as coronaviruses. Additional cleaning with
bleach or alcohol-based products may be required. Be sure to provide hot
running water and soap.
Consider how you will remove waste from your treatment room. You will
likely have clinical waste, i.e., that which has come into contact with
bodily fluids such as sweat (e.g., couch roll/body wipes), general waste
(e.g., non-recyclable packaging) and dry recyclable waste. Sanitary bins
are required for washrooms.
Task: Consider your equipment
Consider the location you are likely to carry out your

massage treatments. Are there any alterations you might
need to make to ensure it’s the best environment possible?
Consider if you might need to purchase any equipment.
Tip: Save this task to use in your business assignment.
Reminder: You are not expected to have all the answers at this
stage. A lot of ideas and best working practices will become
apparent as you continue throughout this course.
Revisit this lesson towards the end of your course and see if there
are any additional considerations that you now have.
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Your massage couch
As discussed in Lesson 3, working positions are designed to protect the working

therapist from muscle or joint strain as well as to allow maximum mobility and pressure
for the treatment. It is essential that you work with a couch that is suitable for the
purpose and is the correct height to maintain your posture whilst performing the
variety of massage strokes required during your treatment.
You will need to choose your couch according to the type of therapies you intend to
offer. Before making your decision, the following questions should be taken into
consideration:
Do my clients need to be able to sit up? If yes, you will require a couch with an adjustable
backrest. If no, then a flat table will probably serve better as they are generally lighter
than the ones with the backrest option
Do I intend using the couch for various therapies or intend to in the future? If you
intend to use the couch for different therapies, then selecting a couch with an
adjustable backrest and adjustable height offers greater versatility and may prove vital.
It is important to look to the future and ask whether there are any other features you
may require from your couch – it’s a big investment.
Do I intend to be the only therapist using the couch or is it intended for various
therapists of various heights? If the couch is going to be shared among students in a
college or therapists in a salon/clinic then adjustable height is a MUST. Adjustable
height couches are adjusted while the couch is on its side, typically with an easy-to-use
spring clip mechanism that is fast, simple and effective. Adjustable height couches are
still of great benefit to a single practitioner as it can be adjusted based on the size of the
client – imagine that your hands will be much higher up on a muscley boxer physique
compared with a very thin person. Adjusting the height of the bed allows you to
maintain the appropriate working position.
What is the right height for me? The widely used general rule is that if you stand
alongside your couch with your fist clenched, then the top of your knuckles should just
brush the top of the couch This is typically at your hip level.
What is the right width to choose?

Different therapies need different
couches of different widths. The standard
610mm width suits most applications. However, if you
know you are going to be working on the big 'rugby
player' type then an extra width bed is most certainly
recommended. Aromatherapy, Massage, Reiki and
Acupuncture are among a few disciplines that tend to
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require a wider couch. When choosing a wider couch, you need to bear 2 things in
mind, firstly, it will add at least 1kgs to the overall weight of the couch and secondly,
will you be able to reach across it.
The alternatives, to an extra wide couch, are the accessories. A face cradle will add extra
length and armrests will add extra width without adding to the weight or size of the
couch when folded.
Is it comfortable? Client comfort is an important factor. Couches come standard with

double foam padding i.e. 40mm thick foam. Make sure the foam padding used is high
density, foam which will not collapse over time.
Is it easy to clean? The vinyl covering should be hardwearing and easy to wipe clean.
Just use a soft wet cloth and soapy water. Do not use any solvents.
What is the maximum weight the couch can take? On average 225 kg. Check with the
manufacturer.
Is there a Warranty? Your couch should have a manufacturer’s warranty, usually 2
years.
Safe Equipment
It is important to review the content around Health & Safety (Lesson 2) and consider how
the regulations apply to your equipment and set up.
You should carry out a risk assessment on your equipment and environment.
Task: Consider your equipment
Consider the following questions. What equipment in your

practice would require electrical testing, for example? Would
any items require you to consider manual handling practices?
Page 50
Useful Links:
https://www.massagewarehouse.co.uk/blogs/blog/massage-treatment-room-design-
inspiration-ideas
https://homeguides.sfgate.com/design-massage-room-52680.html
https://www.direct365.co.uk/blog/salon-waste-disposal/
https://www.medisort.co.uk/how-to-dispose-of-beauty-salon-waste/
Page 51
Lesson 6: Massage Mediums
- Describe why and how massage mediums are used in

body massage;
- Identify different oils suitable for body massage and
their benefits;
- Explain how oils should be safely stored.
Massage Mediums
A massage medium is a lubricant, which helps the therapist’s hands to move freely and
smoothly over the client’s skin.
Reasons for using lubricants in massage:
• Reduces friction between therapist’s hands and the area being massaged
• Improves the gliding movement of the therapist’s hands over the area that is
massaged
• Increases client’s comfort
• Prevents dragging and pulling hairy skin
• Prevents stretching loose, fragile skin
Sensitive skin and allergies
Before using any medium, the therapist may wish to carry out a patch
test, especially if the client has sensitive skin or allergies.
Wash the crook of the elbow with water, dry it and apply a small amount
of the medium onto the skin. Leave for 24 hours and check for any
reactions.
Note: Blended essential oils should not be used

without appropriate aromatherapy training.
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Massage mediums should be selected to suit your client’s skin.
The massage mediums commonly used are oils, creams, powders. Massage waxes and
balms are also popular. Massage mediums are also referred to as base oils, carrier oils or
lubricants.
Medium Notes Advantages / Disadvantages
Oils Many carrier oils have specific beneficial A little oil goes a long way. A
effects on bodily health, as they contain versatile product suitable for
vitamins and minerals in varying degrees most clients. Some clients
don’t like the feel of oil left
Although we cannot absorb most of these on their skin. Oils can stain
vitamins and minerals through application, towels and clothes. Expiry
the benefits to the skin are numerous. Oil can dates should be paid
be warmed gently prior to treatment. attention to as oils can go
rancid.
(See additional table comparing some
common oils).
Creams Tend to be heavier than oils. Use a good Good for small or delicate
quality unscented cream and add a little oil to areas such as the face, or for
increase viscosity if needed hand and foot massages
As they are absorbed more quickly than oils,

they may require more frequent application
Powder Swedish massage is traditionally performed Useful for oily skin, very hairy
(unperfumed) using powder because powder prevents the clients or on clients who
hands from sliding over the surface of the dislike the residues of oils
body and allows deeper pressure and creams.
If used, apply to very dry hands and stroke off

excess to avoid clogging up pores
Never shake onto clients – the ‘dust clouds’

can be irritating for both the client and
therapist
Gels Gels are normally water-based substances, Useful for clients who prefer
non-oily and usually leave no residue. to feel less oily or have
Massage gels on the market may contain naturally oily skin. Gels are
herbal extracts. often rapidly absorbed and
may not be suitable for dry
skin types.
Balms / Typically comprises a combination of carrier Offer good control, low glide,
Waxes oils and beeswax (or vegan alternatives). and good absorption. Can be
Offers a firmer grip and is good for deeper tricky to use on hairy clients
tissue or remedial work. as balms are thick in
Normally packaged in a tub and will require consistency. Watch out for
spatula for hygiene. nut oil blends – avoid for
allergies.
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Methods of application
The oil, cream or powder may
be cold and uncomfortable if
not warmed up and evenly
distributed. The therapist
should dispense a small
amount into the palm of one
hand and then rub the hands
together to warm the medium
and spread it smoothly across
palms and fingertips. Apply to
the client’s skin using effleurage strokes.
Remember
All massage mediums should be dispensed into the therapist’s
hands first, rather than directly onto the client’s skin.
This is for the comfort of the client and an important part of
providing a quality treatment.
Storage and safety precautions of carrier oils

A Material Safety Data Sheet (MSDS) should be available for the oils you purchase. This will
provide health and safety information you need relating to the oil. You should read and
retain this data sheet for your reference. Retain all original labelling if you transfer oils from
their original bottle. Be sure to adequately label bottles of oils. All oils should be kept out of
reach of children and animals.
Typically, oils should be stored in a cool dark place away from extremes of temperature.
Once opened, thus exposed to the air, carrier oils will typically last up to 1 year, but do be
sure to check expiry dates as oils can go rancid. Make sure that the bottles are always
resealed tightly and stored upright. Always check carrier oils are 100% natural - and not
blended with additives, preservatives, perfumes, paraffins or mould inhibitors (parabens).
You may purchase oils in larger bulk bottles, so prior to treatment, transfer some oil to a
dispenser bottle. A typical full body massage will use 20-25ml oil, but more may be required
on dry skin and/or larger bodies. Any leftover oil should be discarded and never poured back
into the original bottle. Always use a clean dispenser bottle for each treatment. Clean any
spillages promptly to avoid hazards.
Buy your carrier oils from a recognised oil supplier, chemist, or health store. A list of
suppliers is included as an additional resource.
Page 54
Top Three Recommended Oils
Sweet Almond oil: Recommended oil for dry skin, though suitable
for all skin types
Grapeseed oil: Suitable for all skin types; a light silky feel and good
for combination skin
Apricot kernel oil: Recommended oil for children and elderly but
suitable for all skin types and sensitive skin
Mineral oils such as baby oil are not recommended for use – as
they dry the skin.
Page 55
Carrier Oil Properties
Latin name Extraction Description Principal Main uses Good for Cautions Cost
method constituents
Sweet Prunus dulcis Cold Pale-yellow Oleic acid (MFA), Excellent Relieving itching, dry, Avoid use on £
Almond Oil pressed oil with a Linoleic acid emollient as it sensitive skin irritated anyone with nut
from the slightly nutty (PFA); softens, skin allergy. If client is
kernels aroma revitalises, unsure, include
Vitamins A, B1, Eases inflammation,
protects and anyone with a
B2, B6, E helpful for rheumatic
nourishes skin family history of
and arthritic
nut allergy
It is one of the conditions.
most useful,
Easing irritation caused
versatile and
by eczema and
multipurpose oils.
psoriasis
Apricot Prunus Cold A pale-yellow Oleic acid (MFA), Excellent for skin Beneficial for aged, No known contra- £
Kernel Oil armenica pressed oil, light Linoleic acid (PFA) protection being prematurely aged, dry, indications
from the textured, Palmitic acid both emollient sensitive and inflamed
kernels slowly (SRA); Vitamins A, and nourishing. skin Helpful with
absorbed oil B1, B2, B6 eczema, dermatitis and
acne.
Page 56
Grapeseed Vitis vinifera Solvent A pale green Oleic acid (MFA), Slightly astringent All skin types. No known contra- £
Oil extracted oil, light Linoleic acid (PFA) – tightens and indications
from the textured, Vitamins A, B6 tones skin Overall
seeds odourless, good emollient
easily
Leaves the skin
absorbed oil
with a smooth
satin finish
without feeling
greasy
Avocado Persea Cold- The unrefined Oleic acid (MFA), All skin types, if A recommended oil for The refined oil is ££
Oil Americana pressed oil is dark Palmitic acid using unrefined dry, dehydrated, dull, pale yellow with
from the green, viscous (SRA) Vitamins A, avocado oil ageing skin and eczema little odour, but
dried fruit and rich with B and D few nutrients
It aids dermal
flesh a distinctive (But does not
regeneration and
green colour stain your towels)
is highly
nutritious The unrefined oil,
due to its viscous
texture for body
massage, it is best
blended with light
carrier oil
Page 57
Evening Oenothera Cold A golden Gammalinolenic Due to its high Eczema, psoriasis, PMT No known contra- ££££
Primrose biennis pressed yellow oil, acid (GLA, PFA), GLA content, the and indications.
Oil from the fine textured Linoleic acid (PFA) oil is valuable for
Menstrual problems.
seeds a wide range of
conditions. Recommended for dry, As an expensive
aging or chapped skin oil - may be used
It is an excellent
as a 50% blend
moisturiser.
with another
carrier oil
Jojoba Oil Simmondsia Cold A pale yellow Myristic acid Jojoba is one of Recommended for No known contra- ££££
sinensis pressed liquid wax, (anti- the most versatile inflamed and irritated indications.
from the light textured, inflammatory carrier ‘oils’. It is skin such as eczema,
beans and highly agent) Oleic acid suitable for all psoriasis, dandruff, and
absorbent (MFA) skin types, acts as a natural Due to its viscous
including sunscreen texture for body
blemished and massage, it is best
oily skin, as it blended with light
helps to nourish carrier oil
and balances the
skin and unclog
the pores.
Key: SFA - Saturated fatty acids; MFA - Monosaturated fatty acids; PFA - Polyunsaturated fatty acids.
Page 58
Lesson 7: Massage and the Body
- Apply anatomical understanding to massage to identify

the effects of massage on each system, whether direct
or indirect.
Massage has an immediate physiological effect on the local area of the body being worked
on and it also affects the whole body through stimulation, and relaxation, of the muscles
and the nerves.
It has physiological and psychological benefits and can affect all the body systems in a
positive way.
Systems directly affected by massage
Effects on the skin (integumentary system)

• Improved circulation to the skin, increased
nutrition to the cells and encouraging cell
regeneration.
• Stroking and rubbing of the skin helps speed up
desquamation which encourages regeneration
of skin cells leading to better skin tone.
• Increased production of sweat from the sweat
glands, helping to excrete urea and waste
products through the skin.
• Vaso-dilation of the surface capillaries helping to
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improve the skin’s colour.
• Improved elasticity of the skin
• Stimulates the sebaceous glands to increase sebum production, helping to improve
the skin’s suppleness and resistance to infection.
Remember
Massage removes dead skin cells. Pores are encouraged to stay open by allowing
increased skin respiration, increasing its suppleness & elasticity – giving the skin a
healthy and glowing appearance.
Effects on muscular system
• Massage relieves muscular tightness, stiffness, spasms, and

restrictions in the muscle tissue.
• It increases flexibility in the muscles due to muscular relaxation.
• It increases blood circulation bringing more oxygen and nutrients

into the muscle. This reduces muscle fatigue and soreness.
• Massage movements such as kneading, wringing and friction
help to separate congested muscle fibers – they break down
fibrocystic nodules and adhesions, improving the elasticity,
strength, and tone of muscles, and relieve muscular fatigue.
Remember
Massage relaxes, stretches & softens muscle tissue - reducing muscular tension and
fatigue.
Effects on the cardiovascular system

• Improve circulation by mechanically assisting the venous flow of
blood back to the heart.
• Dilate blood vessels helping them to work more efficiently.
• Produce an enhanced blood flow; delivery of fresh oxygen and
nutrients to the tissues is improved and the removal of waste
products, toxins and carbon dioxide is hastened via the venous
system.
• Help temporarily to decrease blood pressure, due to dilation of
capillaries.
Remember
A slow relaxing massage strengthens the heart; the rate of the heartbeat decreases, and
high blood pressure may be reduced.
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Effects on lymphatic system
• Reduce oedema (excess fluid in the tissue) by increasing lymphatic
drainage and the removal of waste from the system.
• Regular massage may help to strengthen the immune system, due to
increase in white blood cells.
Remember
When we sustain injuries, there is often a great deal of edema (swelling),
which should be dispersed into the lymphatic circulation.
Massage can help empty the lymph vessels and allow the swelling to
disperse.
Effects on nervous system
• Massage stimulates sensory receptors: this can either stimulate or

soothe nerves depending on the techniques used.
• It also stimulates the parasympathetic nervous system, helping

promote relaxation and the reduction of stress.
• Massage helps to reduce pain by the release of endorphins

(endorphins are also known to elevate the mood).
Remember
A slow, light pressure massage will have a soothing & sedative affect and will provide
relief from nervous irritability.
A vigorous & firm pressure massage will stimulate the nerves and promote an increase
in the activity of the muscles, vessels and glands governed by them – invaluable in cases
of lethargy & fatigue.
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Systems indirectly affected.
Effects on the skeletal system
• Massage can help increase joint mobility by reducing any

thickening of the connective tissue and helping to release
restrictions in the facia.
• It helps to free adhesions, break down scar tissue and decrease

inflammation. As a result, it can help to restore range of motion to
stiff joints.
• Massage improves muscle tone and balance, reducing the physical

stress placed on bones and joints.
Remember
Massage improves the blood and lymph flow in the muscles, which leads to better
circulation in the underlying bones, benefiting their nutrition and growth.
Effects on respiratory system

• Massage deepens respiration and improves lung capacity by relaxing
any tightness in the respiratory muscles.
• It also slows down the rate of respiration due to the reduced
stimulation of the sympathetic nervous system.
• Increases the blood flow to the lungs and produces a better
interchange of gases.
• Helps loosen mucus and eases congestion, especially cupping &
vibration movements.
• Increases lung activity – making them more resistant to infections.
Remember
Massage helps to slow down & deepen the breath – helping the body to relax.
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Effects on digestive system
• Increase peristalsis in the large intestine, helping to relieve
constipation, colic, and gas.
• Promote the activity of the parasympathetic nervous system, which
stimulates digestion.
Remember
As well as helping the digestion and elimination of food, massage also
increases absorption of digested foods & nutrients.
Effects on urinary system
• Massage increases urinary output due to the increased circulation and

lymph drainage from the tissues.
Remember
The use of abdominal and lower back massage promotes the activity of the kidneys
which enhance the elimination of waste products.
Heavy percussion movements should not be performed over the area of the kidneys, as
there is a risk of damage.
Effects on endocrine system

• Helps to carry hormones to the blood plasma.
Remember
The endocrine system and nervous system control & co-
ordinate body functions and maintain the body’s internal
balanced state known as homeostasis.
Regular massage can help maintain this balance.
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Effects on reproductive system
• The use of abdominal & back massage can help alleviate menstrual problems such as
menstrual pains, irregular menstruation, PMS & the symptoms of the menopause.
Remember
Abdominal massage in the first couple of days of menstruation may cause discomfort as
it increases blood flow.
Task: Stress on the body
For each of the systems of the body, research how stress

can affect the system and using the above information,
and wider research as appropriate, summarise how
massage can help to relieve the impact of stress on the
body system.
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Lesson 8: Understanding Muscles
- Describe the structure and shape of muscles;

- Identify common soft tissue disfunctions;
- Locate muscles of the head, face and upper body as well
as describe their action.
The Muscular System

When a muscle is relaxed, there is a good flow of blood to the area, but during contraction, the flow
of blood is reduced and therefore waste removal is limited. This is not a problem if this is occurring
during exercise, as the constant contraction and relaxation allows the blood flow to remain. The
problem can occur if we constantly contract the muscle without it actually moving, such as in sitting
in a poor position, as the blood capillaries can become compressed and blood flow can be impeded,
resulting in an accumulation of waste and a reduction in the delivery of nutrients and oxygen.
Muscles can become fatigued and become weaker and can result in spasm, eventually creating pain.
As the muscles become shorter, they will eventually pull on the tendons that attach them, which can
result in loss of function and pain. As function gradually deteriorates, an imbalance can be caused in
the muscle group and unless the action or activity that started the issue in the first place is not
stopped, the problem will usually re- occur, even after treatment.
If a client is presenting with a sharp pain, this can mean

inflammation in the area and massage should not commence
until the pain has turned into a dull sensation.
How muscles work
Muscle Structure
Muscles are classified into three different types, which are skeletal, smooth and cardiac.
For the purpose of this course, we are mainly going to concentrate on skeletal muscle, as
smooth muscle is mainly found within hollow organs and cardiac muscle is found within the
heart.
Skeletal muscles, also known as striated due to its appearance, or voluntary due to its
action, are attached to bones and deal with movement. These muscles are made up of fine,
thread like fibres of muscles, containing light and dark bands. Skeletal muscles can be made
to contract and relax by voluntary will. They have striations due to the actin and myosin
fibres and create movement when contracted. There are over 650 different types of muscles
in the human body, making up nearly half of the body weight.
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Muscles have the following properties:
Excitability – the muscle responds to stimuli

Contractibility – the muscle shortens due to a nerve impulse
Extensibility – the muscle can stretch and increase its length by half
Elasticity – the muscle will return to its normal length
Muscles consist mainly of muscle fibres which are held together by fibrous connective
tissue, with numerous blood vessels and nerves penetrating through them. The muscle
fibres are made up of muscle cells, which vary in length and are rod shaped. The fibres are
called myofibrils and they get shorter (contract) in response to a nerve impulse. The protein
strands then slide against each other when the muscle contracts.
Each muscle fibre has an individual wrapping of a fine connective tissue called endomysium,
which are then wrapped into bundles called fascicule and are covered by the perimysium.
This is what forms the muscle belly, and has its own covering called the fascia epimysium.
The fascia acts as a “Clingfilm” around muscles, giving them support and also acts as a
pathway for nerves, blood and lymph vessels.
When a muscle is damaged, fibres become torn and the connective tissue around the
muscle is also damaged. Fluid seeps out of torn fibres, which can cause localised swelling.
This fluid tends to stick the fibres together which causes pain as the muscle is irritated by
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the slightest contraction. The fibres stop sliding as effectively and the fascia gets tighter and
begins to constrict the muscle. The fascia can also become torn and the loss of elasticity can
create tissue congestion. If the body is held in the same position for too long, such as sat at
a computer, then the fascia can easily adapt to that shortened position, and any attempts to
return it to its normal length can be painful. There is then a temptation to remain in that
position, which in turn worsens it.
Muscle Shapes
The bundles of fibres within muscles will determine the shape of the muscle. The most
common muscle fibre arrangements are:
Parallel fibres – these muscles have fibres that run parallel to each other in length and can
sometimes be called strap muscles. These muscles have great endurance but may not be
that strong due to their length. An example would be the Sternocleidomastoid (SCM).
Circular muscles – these muscles are usually circular in shape and an example would be the
muscles surrounding the mouth and eye.
Convergent – this is where the muscle fibres converge to an attachment to a bone. The
fibres are arranged to allow maximum force and can sometimes cross joints which have a
large range of movement such as the Pectoralis Major.
Pennate – these are made up of short fibres, so the pull is short but also strong, though the
muscle tires easily.
Fusiform – these are sometimes included within the parallel muscle group and are made up
of spindle shaped fibres. A good example is the Biceps Brachii as the belly is wider than the
origin and the insertion.
Muscle Movement
You need to know a little about how your muscles work in pairs, and all the terminology
used to describe this.
Muscles are attached to two different bones with tendons.

To make a joint move one of these bones move whilst the other will not.
c. The insertion is the point where the muscle is attached to the moving bone.
An example of this is: - The origin of the bicep is attached to the shoulder and the insertion
of the bicep is attached to the forearm/elbow joint.
Antagonistic Muscles Work in Pairs: Muscles can only do one thing and that is to pull (by
contracting). To make a joint move in two directions, you need two muscles that pull in
opposite directions.
• Antagonistic muscles are pairs of muscles that work each other.

• One muscle contracts (shortens) while the other relaxes (lengthens) and vice versa.
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• The muscle that is doing the work (contracting) is the prime mover or agonist.
• The muscle that is relaxing is the antagonist.
Muscles called flexors and extensors occur opposite each other. Flexors make joints close
(flexion) while extensors make joints open (extension). Adductors and abductors are
another pair of opposite muscles that work together in joints.
There are Two Types of Muscle Contractions: There are two types of contraction that a
muscle can undergo, these are isometric and isotonic.
• Isometric Contraction - the muscle stays the same length and so nothing moves. Like
if you pull on a rope attached to a wall.
• Isotonic Contraction - the muscle changes length and so something moves. Like if
you exercise with weights that are free to move.
Effects of Using Muscles and Muscle Contraction: If you use your muscles constantly or you
under use them several things can happen.
• Muscle Fatigue - if you use your muscles a lot and they don't get enough oxygen they
will feel tired or fatigued.
• Muscle Atrophy - if you don't use them, they will get smaller, this is called atrophy.
• Cramp - Cramp is a sudden contraction of a muscle that won’t relax.
Muscles never relax completely, there is always some tension in them, and this is called
muscle tone. Exercise improves muscle tone, which in turn improves posture, if you improve
your posture you put less strain on your muscles, joints and bones and you won’t get injured
so easily.
Flexibility: Flexibility, suppleness and mobility are all basically the same thing; they are all to
do with how far your joints move, the type of joints you have and the stretchiness of the
muscles around it.
Flexibility has many benefits - It’s often forgotten about but suppleness is very useful for any
sport, the reason for this is:-
• Stretches get you ready to work

o Stretching is a good way to warm up and get your body ready to work this
means you are less likely to pull or strain a muscle.
• Better performance
o You can’t do some sports without being flexible like gymnastics and
trampolining.
• Fewer injuries
o If you are flexible you are less likely to over stretch and injurer yourself.
• Better posture
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o More flexibility means better posture, fewer aches and pains prior, during
and after training. Flexibility in certain joints is especially important because
they are used all the time in sports.
Active Stretching:
• You do the work of stretching your muscles without help from an external source.
• You take it slowly and gentle.
• If it hurts or your muscle starts to shake, ease up.
• Don't bounce into a stretch because this will tear your muscle fibres.
Passive Stretching:
• A partner does the hard work of stretching your muscles.

• Tell them straight away if you feel any pain.
Growth and Repair of the Muscles
Muscle hypertrophy is the term used for when a muscle cell grows in size, and the
commonest reason for this is due to exercise, where there will be an increase in muscle
fibre. When a muscle is damaged (torn), the body has to repair it and will do this by using
satellite cells which fuse with the ends of the damaged fibre. If the damage is constant, then
the process will repeat itself so that more satellite cells are used which will create growth of
the muscle.
Muscle Tone
Muscle tone refers to the amount of tension or resistance to movement in a muscle. Muscle
tone is what enables us to keep our bodies in a certain position or posture. A change in
muscle tone is what enables us to move. For example, to bend your arm to brush your
teeth, you must shorten (increase the tone of) the bicep brachii muscles on the front of your
arm at the same time you are lengthening (reducing the tone of) the tricep brachii muscles
on the back of your arm. To complete a movement smoothly, the tone in all muscle groups
involved must be balanced. The brain must send messages to each muscle group to actively
change its resistance.
Tendons and Ligaments
Tendons and ligaments are made up of collagenous tissue with ligaments attaching bone to
bone and tendons attaching muscle to bone. The place where a muscle attaches to a bone
but does not move, is known as the origin. To make movement occur, the muscles contract,
which will pull on the tendons, this then pulls on the muscles.
Tendons are tough, yet flexible bands of fibrous tissue, which allows movement. Ligaments
are stretchy connective tissue which helps to stabilise the joints. They control the range of
movements of a joint to prevent them from bending the wrong way. Injuries to both
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tendons and ligaments are very common, caused mainly by sporting injuries. It is fairly
common for tendons to be stretched or torn which can be extremely painful. If ligaments
are stretched, caused by injury or excess strain, the joint will become weaker, as the
ligaments are unable to support it.
As discussed, the muscles within our body act when they receive impulses. The nervous
system is the means by which the body co-ordinates bodily systems and informs the body
about any changes in the environment.
The nerves carry brief electro-chemical messages that trigger appropriate responses in the
various parts of the body. The messages (impulses) then react and will do certain tasks such
as make the muscles contract, the glands secrete, and the blood vessels widen or narrow.
The nervous system is a very complex system in the body but is divided up into two main
parts. The Central Nervous System (CNS) and the Peripheral Nervous System (PNS).
Musculo-Skeletal Problems
Very often, the problem will not be noticed for a long time and the symptoms can be very
subtle at first. This can make it difficult to be able to determine the cause of the problem.
However, below are some of the most common causes.
Stress – emotional stress will usually show itself in physical tension, causing tight muscles
and poor posture.
Environment – by looking at the client’s lifestyle and occupation, a pattern may form that
could highlight a potential problem. Such activities as walking a dog which pulls on a lead or
carrying heavy bags over the shoulder can often lead to problems.
Injury – any type of injury will cause the soft tissue to become swollen and may lead to
increased muscle tension or spasm. This can lead to a lack of range of motion. If you suspect
an injury, always refer your client to a professional such as osteopath, physiotherapist or GP.
Posture – postural problems may be due to bad habits, but they may also be due to postural
faults, such as those below:
It is rare for a person to have ideal postural alignment where all the natural
curvatures are present and aligned (plumb line).
More often they present with specific imbalances (tightness or weakness) that create
increased or decreased curvatures of specific areas. Those most frequently observed
include: hyperlordosis, hyperkyphosis, flat back, sway back and scoliosis. These are
explained and movement recommendations are provided in the table- posture types.
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Flat back Hyperkyphosis Hyperlordosis Hyperkyphosis
Hyperlordosis
Scoliosis
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Posture types
Posture type Observable Weak/long Short/strong
Action
features muscles muscles
Hyperlordosis Deep, hollow Hamstrings Back extensors
curve of lumbar • Gluteals (possibly)
spine abdominals Hip flexors
Hyperkyphosis Lower and
• Neck extensors
middle
• Pectorals
Hunched back trapezius
• Anterior deltoid
Rhomboids
• Upper trapezius
Neck flexors
Flat back Hip flexors
Flat lumbar
Back may be Stretch
spine and
long but not Hamstrings short
posterior pelvic
necessarily muscles
tilt
weak Strengthen
Sway back • Hip flexor • Hamstrings weaker
Hip forward of • External Internal oblique muscles
plumb line and obliques • Lumbar
backward Upper back extensors(may be
leaning extensors strong, but not
• Neck flexors short)
Scoliosis • Asymmetrical
differences
• One side Other side
• Lateral
convexity concavity
deviation more
than 10°
Scoliosis
As a massage therapist, this is where caution is needed. Focus
on the massage being mindful of pressure close to the spine.
If scoliosis is severe, only a relaxing massage, with lots of
effleurage, petrissage, and other relaxation techniques, is
appropriate.
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Soft Tissue Dysfunction
Before you start massage, you will need to be able to assess the condition of the
muscles. Here are a few guidelines to help you.
Acute pain If client experiences acute pain that lingers, stop massaging the area and
suggest they see a GP for diagnosis
Adhesions Adhesions are fibrous bands that form around joints or within the fascia layers.
The muscle fibers or the fascia stick together and eventually fibrous nodules
develop – the area feels fibrous and less flexible. They are usually caused by
inflammation or injury and the release of adhesive glycoprotein’s which aid the
repair process. They seldom cause acute pain when worked over but they can
cause discomfort and sensitivity. You may know adhesions as “knots”.
Crystal Found on muscle fibers and around bone structures: e.g. around the edge of
Deposits the scapular. Can feel gritty and ‘crunchy’ and can cause pain when worked
over
Edema Excess fluid in tissues. Test by applying pressure to the area, if the area
stays white for longer than 10 seconds it is edema. Extremely swollen
areas will be firm, even solid with little movement and pain due to
excess fluid pressure on the sensory nerves. Avoid area and work
softly above area to aid drainage
Fibrosis Occurs when excess fibrous connective tissue forms usually due to tissue
damage such as repetitive strain
Fibrous Located close to the surface of the skin. They are moveable, often jumpy and
Nodules the areas will feel lumpy. They seldom cause acute pain when worked over
but they can cause severe discomfort and sensitivity
General Muscle fibres will be hard and difficult to move. Unlike a toned muscle,
tension which can feel hard but will be pliable and will move with you as you
massage over it. With deep held tension the area will become sensitive to
touch and often ticklish
Inflammation Symptoms to look out for are: redness, heat, pain, swelling
Muscle A convulsive muscular contraction which can be a result of tissue damage
spasms as the natural response is to contract nearby muscles. They can also occur
if a muscle is overworked or over stretched. The contraction of the muscle
fibres can compress on blood vessels and with a build-up of toxins in the
muscle, the nerves can become irritated, causing pain.
Scar tissue The body’s natural response to injury, and its aim is to bring two ends together,
for example in a torn muscle. It is also made of elastic fibres but also collagen
and can be sticky in its early stages, causing the fibres to adhere together,
causing muscle fibres to clump together over time and preventing the fibres
from gliding. Not as mobile or pliable as normal tissue. Old scar tissue will feel
lumpy or solid with no flexibility. New scar tissue will feel firm with little
flexibility. The muscles affected will feel stiff and inflexible.
Tearing There will be a dip or a hole in the muscle contour and acute pain. Advise
client to see a GP. Do not massage
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Muscles of the body
Muscles of the posterior body
Deep muscles
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Muscles of the anterior body
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Muscles of the Chest and Upper Arm
Name Position Action
Pectoralis
Across upper chest Used in throwing and climbing; adducts arms
major
Pectoralis Underneath pectoralis
Draws shoulders downwards and forwards
minor major
Deltoids Surrounds shoulders Lifts arms sideways, forwards and backwards
Biceps Front of upper arm Flexes elbow; supinates the forearm and hand
Triceps Back of upper arm Extends the elbow
Brachialis Under the biceps Flexes the elbow
Muscles of the Hand and Forearm

On the thumb-side of
Brachio radialis Flexes the elbow
the forearm
Middle of the
Flexors Flexes and bends the wrist drawing it towards the forearm
forearm
Little finger side of

Extensors Extends and straightens the wrist and hand
the forearm
Palm of the hand

Thenar muscle Flexes the thumb and moves it outwards and inwards
below the thumb
Hypothenar Palm of hand below

Flexes little finger and moves it outwards and inwards
muscle little finger
Muscles of the Back

The back of the neck
Trapezius Moves scapula up, down and back; raises the clavicle
and collarbones
Latissimus Used in rowing and climbing; adducts the shoulder
Across the back
dorsi downwards and pulls it backwards
Three groups of
Erector muscles which lie either
Extends the spine; keeps body in an upright position
spinae side of the spine from
the neck to the pelvis
Rhomboids Between the shoulders Braces the shoulders; rotates the scapula.
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Muscles of the Abdomen
Rectus Flexes the spine; compresses

Front of abdomen from the pelvis to the sternum
abdominis the abdomen; tilts the pelvis
Internal – either side of the rectus abdominis Both compress the abdomen
Obliques
External – lies on top of the internal oblique’s and twist the trunk
Muscles of the Buttocks and Legs

Abducts and rotates the femur; used in walking and

Gluteals In the buttocks
running
Hamstrings Back of the thigh Flexes the knee; extends the knee
Gastrocnemius Calf of the leg Flexes the knee; plantar-flexes the foot
Calf of leg, below

Soleus Plantar-flexes the foot
the Gastrocnemius
Front of the thigh:

Quadriceps
group of four Extends the knee; used in kicking
extensor
muscles
Crosses the front of Flexes the knee and hip; abducts and rotates the
Sartorius
the thigh femur
Adductors Inner thigh Adducts the hip; flexes and rotates the femur
Front of the lower Inverts the foot; dorsi-flexes the foot; rotates the foot
Tibialis anterior
leg outwards
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Muscles of the Face and Head
Forms most of the
Puffs out cheeks when blowing; keeps food in
Buccinator cheek and gives it
mouth when chewing
shape
Inner corner of
Corrugator Draws eyebrows together (frowning)
eyebrows
Upper part of the
Frontalis Elevates eyebrows; draws the scalp forwards
cranium
Runs down and back Lifts the jaw; gives strength for biting (clenches
Masseter
to the angle of the jaw the teeth)
Mentalis Forms the chin Lifts the chin; moves the lower lip outwards
Nasalis Over the front of nose Compresses nose (causing wrinkles)
Orbicularis Oculi Surrounds the eye Closes the eye (blinking)
Surrounds the lip and
Orbicularis Oris Closes the mouth; pushes lips forwards
forms the mouth
Front of throat
Platysma Pulls down the lower jaw; angles the mouth
Top of nose between Depresses the eyebrows (forms wrinkles over the
Procerus
eyebrows nose)
Quadratus labii Runs upward from the
Lifts the upper lip; helps open the mouth
superiorus upper lip
Risorius Lower cheek Pulls back angles of the mouth (smiling)
Pulls head down to shoulders; rotates head to
Sternocleidomastoid Either side of the neck
side; pulls chin onto chest
Runs downs the side
Temporalis Aids chewing; closes mouth
of face towards jaw
Corner of the lower
Triangularis lip, extends over the Pulls the corner of the chin down
chin
Runs down the cheek
Zygomaticus towards the corner of Pulls corner of the month upwards and sideways
the mouth
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Example Actions of Muscles
Head / face / neck muscles and their actions
Muscles Example Action
Buccinator Compresses cheeks as in whistling

Depressor anguli oris Pulls down corners of mouth Creates the expression of sadness
Depressor labii inferioris Pulls lower lip down
Frontalis Draws scalp forwards
Lateral Pterygoid Opens mouth
Levator Anguli Oris Raises corner of mouth Creates cheerful expression
Lift upper lip
Levator labii superioris
Creates cheerful expression
Levator palperrae Opens eyelid
Masseter Closes mouth and clenches teeth Chewing food
Medial Pterygoid Raises the mandible (lower jaw)
Lifts skin on chin and draws lower lip outwards Creates the
Mentalis
expression of discontent
Compresses and dilates nasal opening
Nasalis
Creates annoyed expression and used in sniffing
Occipitalis Draws scalp backwards
Lifts eyebrows, wrinkles skin of forehead Creates looks of surprise
Occipito-Frontalis
and horror
Orbicularis oculi Closes eyelids

Orbicularis oris Purses the lips / compresses lips against teeth
Procerus nasi Wrinkles skin at bridge of nose Creates expression of disgust

Retracts corners of mouth and lifts upper lip up Creates expression
Risorius
of grinning
Splenius capatis Looking up or down

Flexes & turns head from side to side Shaking head – saying ‘No’
Sternocleido mastoid Looking over your shoulder
Raising your head from pillow
Temporalis Raises and retracts the lower jaw / clenches teeth
Moves angle of mouth up, back and outwards Creates the
Zygomaticus
expression of smiling
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Trunk - front and back shoulder / upper arm muscles
External Oblique Dancing the twist / Gymnastics

Internal Oblique Digging with a shovel, raking / Golf
Diaphragm Produces 60% of our breathing capacity
Transverse Abdominis Support when sneezing and coughing / maintains good posture
Seated rowing, Javelin
Rectus Abdominis Initiating getting out of a low chair / All sports

Quatratus lumborum Bending sideways from sitting to pick up an object from the floor
Tennis serve
Gluteus maximus Walking upstairs / rising from sitting / Running / High jumping
Gluteus medius Stepping sideways over an object, such as a low fence / Ice skating
Gluteus minimus Stepping sideways over an object, such as a low fence / Ice skating
Erector spinae Keeps back straight / maintains posture

All sports, especially swimming, gymnastics, ballet
Rotators located Rotates and assists in extension of the vertebral column
between each vertebra Helps maintain good posture and stability during standing and
sitting
Trapezius Painting a ceiling / Boxing
Levator scapulae Carrying a heavy bag over your shoulder / Weightlifting
Rhomboids minor & Pulling something toward you, such as opening a drawer Archery /
major Wind surfing
Pectoralis major Clavicular attachment – brings arm forward and across the body, as
in applying deodorant to opposite armpit
Sternal attachment – pulling something down from above, such as
a rope in bell ringing / Baseball pitching
Latissimus dorsi Pushing on arms of chair to stand up / Climbing , Rowing
Deltoid Reaching for something out to the side, or raising the arm to wave /
Javelin, Wind surfing
Supraspinalis Holding shopping bag way from side of body / Racket sports
Infraspinalis Brushing back of hair / Racket sports

Teres minor Brushing back of hair / Racket sports
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Teres major Reaching into your back pocket / Cross-country skiing / Rowing
Subscapularis Reaching into your back pocket/ Athletic throwing events

Biceps brachii Picking up an object- bringing food to your mouth / Rowing
Brachialis Bringing food to your mouth / Rowing, Boxing
Triceps brachii Throwing objects, pushing a door close / Volley ball
Lower arm muscles / hands

Pronator teres Pouring liquid from a container / turning door knob Hockey
dribbling
Brachio radialis Turning a cork screw / Cricket
Supinator Pushing a door handle / Backhand in all racket sports
Extensor carpi Kneading dough, typing, cleaning windows Motor cycle
Radialis, longus, sports- throttle control
brevis
Wrist extensor
Opponens pollicis Picking up small object between thumb and fingers Motor
cycle sports – clutch and throttle controls
Extensor digitorum Letting go of objects held in hand
Finger extensors
Hip and leg / foot muscles

Muscles: Example Action:
Tensor fasciae latae Walking and strolling / Horse riding, Hurdling

Piriformis Taking first leg out of car / Swimming (breast stroke legs)
Soccer
Adductor Bringing second leg in or out of the car / horse riding / Soccer
Magnus, longus,
brevis
Hamstrings During running the hamstrings slow down the leg at the end
of its forward swing and prevent the trunk from flexing at the
hip joint / Sprinting / Cross country running
Gracilis Sitting with knees pressed together / Horse riding
Sartorius Sitting cross-legged / Ballet, Ice-skating
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Quadriceps Rectus Walking up the stairs / Cycling, Skiing / All jump events
femoris
Vastus lateralis &
medialis
Tibialis anterior Walking and running – lifts foot clear of the ground as the legs
swings forward / Hill walking, Mountaineering
Gastrocnemius Standing on tip-toe / High jumping, Volley ball, Ballet
Soleus Standing on tip-toe / High jumping, Volley ball, Ballet
Extensor digitorum Walking up the stairs – ensuring the toes clear the steps Hill
Longus / Hallucis walking, Mountaineering
longus
Flexor hallucis longus Pushing off the surface when walking / Hill walking / Ballet
Fibularis (Peroneus) Walking on uneven surfaces Running, Soccer, Jumping
Longus and brevis
Muscles of the body
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Useful links:
http://www.thestretchinghandbook.com/
http://www.getbodysmart.com/ap/muscularsystem/menu/menu.html
http://www.innerbody.com/htm/body.html
http://www.bbc.co.uk/science/humanbody/body/factfiles/muscle_anatomy.shtml
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Lesson 9: The Skin
- Describe the structure of the skin and identify key

elements;
- Identify and describe different skin types and disorders.
The Skin Structure

Skin makes up around 12% of an adult’s body weight. It’s very adaptable and able to mold
into different shapes, covering bones and muscles to perform various functions of the
body’s make up.
The functions of skin are:
• Sensation - Main sensory organ for temperature, pressure, touch and pain.
• Heat Regulation - Regulates the body temperature by sweating to cool the body
down when it overheats, and shivering when the body is cold.
• Absorption – Some creams, essential oils and some medication can be absorbed
through the skin.
• Protection – Too much UV light may harm the skin, so the skin protects itself by
producing a pigment, seen in a tan, called melanin. Bacteria and germs are
prevented from entering the skin by a protective barrier called the Acid Mantle. This
barrier also helps protect against moisture loss.
• Excretion – Waste products and toxins are eliminated from the body through the
sweat glands.
• Secretion – Sebum and sweat are secreted onto the skin’s surface. The sebum keeps
the skin lubricated and soft and the sweat combines with the sebum to form the acid
mantle.
• Vitamin D production - Absorption of UV rays from the sun helps formation of
vitamin D, which the body needs for the formation of strong bones and good
eyesight.
There are 3 major layers of the skin, the Epidermis, Dermis and the Subcutaneous.
The Epidermis Layer

The outermost layer of the skin is called the epidermis layer. There are no blood vessels in
the epidermis but it’s the deepest layer and is supplied with lymph fluid. It is thickest in the
palms and on the bottom of the feet.
There are various layers of cells within the epidermis, the outermost of which is called the
stratum corneum (or horny layer). The layers can be seen clearly in the diagram of the skin.
The surface layer is composed of twenty-five to thirty sub-layers of flattened scale-like cells,
which are continually being cast off by friction and replaced by the cells of the deeper
epidermal layers.
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The surface layer is considered the real protective layer of the skin. The cells are commonly
called keratinised cells because the living matter within the cell (termed protoplasm) is
changed to a protein (keratin) which helps to give the skin its protective properties.
New skin cells are formed in the deepest layer within the epidermis. This area is called the
stratum basale (or basal/germinative layer). The new cells will gradually move towards the
outer layers of the skin as the stratum corneum is shed. The new cells gradually change in
form as they move upward to the outer layers, becoming keratinized in the process.
Layers of the Epidermis
English Name Latin Name
Horny Layer Stratum Corneum

Clear Layer Stratum Lucidum
Granular Layer Stratum Granulosum

Prickle Cell Layer Stratum Spinosum
Basal/Germinative
Stratum Basale
Layer
The Dermis Layer

The dermis is a tough and elastic layer containing white fibrous tissue interlaced with yellow
elastic fibres.
Many structures are embedded in the dermis including:
• blood vessels
• lymphatic capillaries and vessels
• sweat glands and their ducts
• sebaceous glands
• sensory nerve endings
• the erector pili - involuntary muscles are sometimes activated in cold weather to give
'goose bumps’
• hair follicles, hair bulbs and hair roots.
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The Subcutaneous Layer
This layer of skin is located on the bottom of the skin diagram. It connects or binds the
dermis above it to the underlying organs. The subcutaneous layer is mainly composed of
loose fibrous connective tissue and fat (adipose) cells interlaced with blood vessels. The
hypodermis (subcutaneous layer) is generally about 8% thicker in females than in males. The
main functions of the hypodermis are insulation, storage of lipids, cushioning of the body
and temperature regulation.
Diagram of the Skin
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Skin Types
Basic skin types are determined by genetic disposition and will have become apparent in the
early teens. Most people know their skin type, but if you are unsure, the following pointers
should help.
• Youthful skin
• Mature skin
• Normal skin
• Dry skin
• Oily skin
• Combination skin
• Sensitive skin
The difference between youthful and mature skin

The structure and elasticity of healthy young skin
Young skin contains large amounts of Hyaluronic acid (HA)
Hyaluronic acid is a natural sugar found in all living cells that attracts and binds water,
hydrating the skin and giving it volume.
Hyaluronic acid also affects some of the other components of skin structure such as
collagen and elastin, as well as the function of skin cells
In these ways, Hyaluronic acid is very important in maintaining the structure and
function of young skin, helping it to look healthy, feel smooth and elastic
Skin changes with aging

As we get older, Hyaluronic acid is lost from the skin
Women aged 75 years have approximately four times less HA in their skin than women
aged 19 – 47.
This decrease in HA contributes to some of the signs of ageing – loss of skin hydration,
skin thinning and decreased ability for the skin to restore itself
Useful link: http://www.medterms.com/script/main/art.asp?articlekey =25768
skin thinning and decreased ability for the skin to restore itself.
Young skin
If the natural oils in the skin are well
balanced the skin remains healthy and is
considered young / normal
Young / normal skin tends to be:
• Soft subtle & smooth with a

velvety feel to it
• Appearance similar to a young
child / good elasticity
• No areas of excess oiliness or
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dryness
• Skin is balanced throughout with perhaps a slight oiliness in the T – zone
• Clear appearance with a fine-grained texture / small pores
Recommended Carrier oils:

• Apricot Kernel
• Sweet Almond
• Jojoba
Mature skin
This skin is usually very dry, lacking both oil & moisture, and is developing wrinkles and
lines.
Mature skin tends to have:

• Expression marks around the eyes,
nose and mouth
• Slackness around the eyes
• Dull complexion with loss of skin
elasticity and natural moisture
• Fine network of veins, broken
capillaries
• Age spots
Recommended Carrier Oils:

• Apricot Kernel
• Jojoba
• Evening Primrose
• Avocado
Dry Skin
Dry skin lacks the surface oils, which give normal / young skin its smooth velvety feel.
It is often delicate & sensitive and tends to

have:
• Dull appearance with a dry and
course feel to it
• Often flaky & chapped and feels
‘tight’ after washing
• Finely textured and prone to broken
capillaries
• Creases visible
• Feels tight after washing
• Sensitive to cold
Recommended carrier oils:

• Sweet Almond
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• Avocado Jojoba
Oily Skin
Oily skin is caused by overactive sebaceous
glands, which secrete too much sebum.
This skin type is prone to breakouts and

tends to have:
• Shiny look with a greasy feel to it
• Course grained tex
• ture and dilated pores
• Blackheads, acne and skin blemishes
due to excess sebum clogging up the
pores
• Not generally sensitive
Recommended carrier oils:

• Apricot Kernel
• Jojoba
Combination Skin
Combination skin is a mixture of dry skin with oily patches on the T – zone, where the
sebaceous glands are more productive and generally it is best to treat each area
separately, using the appropriate oils.
Combination skin tends to be:

• Partly dry and partly oily / different appearance between T – zones
• Prone to dilated pores and blackheads on the T – zone

• Apricot oil
• Jojoba
Sensitive Skin
This skin type is prone to sensitivities and allergies, particularly to the chemicals and
fragrances found in many skin care products.
Sensitive skin tends to be:

• Pale, dry and fine textured
• Sensitive to many products (burning sensation)
• Sensitive to sunlight, developing red, scaly patches
• Develop red blotches and broken veins in extreme temperatures
• Poorly protected due to insufficient epidermic oils
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• Apricot Kernel
• Jojoba
Skin Colouring and Presentations

The skin owes its coloring to the red hemoglobin found within the blood vessels, yellow
carotenoids within subcutaneous fat and the dark brown pigment, melanin. Various
degrees of pigmentation are present in different ethnic groups. The differences are in
the amount of melanin produced and not dependent upon the number of melanocytes
present.
Albinism
Some people are born without the ability to produce melanin within their skins and with
no hair pigment – a congenital condition called albinism. People with this condition have
pure white hair, white skin and pink eyes.
Lesions
Lesions are growths or abnormal patches of skin that do not resemble the area of skin
around them. Many cause no ill effects; others are more serious and require treatment.
Bulla A raised, fluid-filled legion larger than a vesicle

Fissure Crack or break in the skin
Macula Flat colored spot
Nodule Solid raised lesion larger than a papule, often a symptom of a systemic
disease
Papule Small circular raised lesion at the surface of the skin
Plaque A broad, raised area on the skin
Pustule A raised lesion containing pus – often in a hair follicle or a sweat gland
Ulcer A lesion resulting from the destruction of the skin and often as deep as the
subcutaneous tissue
Vesicle Small, fluid-filled raised lesion, a blister
Wheal Small, rounded, slightly raised area, often itching and can be seen as hives
(Urticaria) when a person suffers an allergic reaction.
It is important to be able to identify (not diagnose!) which

skin presentations may be cause for concern or contra-
indications and which are completely innocuous and simply
part of beautiful human variation.
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Skin Diseases and Disorders
Name Appearance Cause

Dermatitis Inflammation of the skin, Allergic reaction to contact
swelling & redness with allergen
Seborrheic Warts Flat top/warty looking lesions Ageing
Herpes simplex Red sore/scab usually on side of Viral infection transmitted by

the mouth also none as a cold contact with another infected
sore area. Highly contagious
Scabies Itchy white spots Mite transmitted by direct skin
to skin contact typically from
itchy infected area and
transporting mite to someone
else under fingernails.
Psoriasis Red itchy scaly patches erupting The immune system sends out
on skin a faulty signal that speeds up
the growth cycle of skin cells
Acne Rosacea Redness on nose and cheeks Dilation of minute capillaries in

the skin
Impetigo Red spot which blisters then Highly contagious. Spread

discharges developing a yellow through direct contact and
crust itching
Milia Same as dermatitis: redness is Allergic reaction.

due to dilated blood vessels and Stress
as fluid accumulates itching, and
swelling occurs. Weeping skin
can then become infected
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Lesson 10: Contra-indications to Massage
- Explain the contraindications to massage treatment:

▪ requiring medical consent
▪ total contra-indications
▪ local contra-indications
- Describe appropriate course of action for common
conditions.
Massage is non-invasive, relaxing, and is generally considered a safe treatment for most
people. However, there are two types of contra-indication:
• With GP, medical or specialist permission (or a signed indemnity form)

• Contra-indications that restrict treatment (either totally or locally)
Before commencing with any treatments, it is vital the client is checked for contra-
indications.
Does a contra-indication mean a treatment cannot take place?
Not always, however if you are concerned about giving a massage or unfamiliar with a
condition, it is best to refer the client to their GP for advice. Remember, that the client
is likely to know a fair amount about their condition, so ask them to tell you more about
it.
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The importance of obtaining informed consent and working within
boundaries
Informed consent should be obtained from all clients prior to any physical
assessments and treatment. It is both a legal and ethical requirement.
To ensure client consent is informed, it is important to:

• Explain to the client the purpose of the assessments and treatment
• Explain and discuss with the client what will happen in the assessment
and treatment (including positioning, robing and draping and the
techniques and mediums used) using language that is accessible and easy
to understand
• Explain professional qualifications, experience, expertise and scope of
practice, e.g. when it may be necessary to refer to another healthcare
professional or when it may be necessary to defer a treatment
• Explain and discuss with the client the benefits and any potential risks
associated with assessment and treatment, e.g. muscle soreness or
unsuspected allergic reactions to massage mediums
• Explain any contra-indications for treatment
• Explain that all information is confidential and will not be disclosed to other
parties, without consent from the client
• Explain that any identified need for disclosure of information (e.g. to a GP)
would be on a need to know basis
• Answer any questions fully and record both the questions asked and
answers provided
• Sign and date the consent form (client and therapist)
The scope of practice in massage

Cautions and contra-indications – definitions and differences
It is important for all professionals to work within the scope of practice for the
profession and not exceed role boundaries. Awareness of the contra-indications
and cautions for providing massage treatments and knowing when to refer clients
to other professionals is one example of a professional boundary that must be
maintained. This ensures professional standards are maintained and client safety is
central to the service being provided.
Caution
A caution would present if a client has a medical condition or injury that is

considered a risk, but there are adaptations and modifications that can be
made to the treatment to minimise any potential risk, e.g. avoiding the
area.
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A caution is when modifications and adaptation can be made to the treatment
in response to reduce the possibility of any identified risks.
Precautions and modifications to treatment may include: adapting the treatment

strategy, e.g. techniques used, avoiding a specific area of the body, adapting the
client's position during the treatment and/or using a different massage medium.
An example of a contra-indication would be if a client has a health condition or

injury that could be aggravated or made worse by the treatment.
Contra-indications can be local or systemic.
Local contra- These can be sometimes be treated, but an element of

indications caution is needed, and massage must be adapted to the
condition, e.g. the contra-indicated area should be avoided
Systemic contra- These should NOT be treated. Treating a systemic contra-

indication indication may negatively affect the client's health. They
should be referred to a health professional
Absolute contra- These should NOT be treated. The risks are significantly
indication high
and outweigh any potential benefits. If massage is
performed it may potentially result in serious harm (in
extreme circumstances permanent disability)
Chronic absolute These are long term illnesses that should not be treated.
contra-indications Massage could progress the illness causing further
associating health related problems
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Some contra-indications may be acute (short term). They need time to heal naturally,
or with medical intervention, e.g. medication. Once recovered, they may be treated
as long as medical clearance is provided.
The massage therapist must be able to identify the signs and symptoms of conditions
that would offer a caution or contra-indication for treatment. These will usually be
identified during the client consultation and assessment.
When identified, the therapist should explain why these conditions offer risk and
explain the action they need to take, e.g. contra-indications will need to be referred
to a healthcare professional; whereas, cautions can be treated as long as the
treatment is modified and adapted, e.g. avoidance of an area.
If cautions are present The benefits and risks should be discussed fully with
the client and treatment should only proceed if the
client gives their informed consent.
If contra-indications are These should also be discussed with the client. The
present aim should be to reassure the client, without causing
alarm. The massage therapist should explain that only
medical professionals are trained and qualified to
make informed decisions on the appropriateness of
treatment for some conditions and the therapist's
action is to ensure client safety.
In the rare circumstances that a contra-indication is missed during assessment

and is instead identified during treatment, through palpation or conversation,
the therapist should:
• Stop the treatment
• Discuss the reasons for stopping the treatment with the client (again, without
causing alarm)
• Signpost the client to the appropriate health professional
To minimise the likelihood of this occurrence, the therapist should summarise all
information gathered during the assessment, check client understanding and prompt
the client to disclose any other information that may influence the safety and
benefits of the treatment.
Post-treatment - any negative effects reported by the client following a treatment
should also be signposted to a health professional. No further treatment should be
performed until medical clearance has been provided.
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Commonly seen contra-indications
Local contra- Absolute contra- Chronic absolute contra-

indications indications indications
▪ Abnormal lumps ▪ Chickenpox ▪ Blood clots
▪ Athlete's foot ▪ Diarrhoea ▪ Deep vein thrombosis
▪ Blisters ▪ Fever ▪ Hypertension
▪ Bruises ▪ German measles ▪ intestinal
▪ Carpal tunnel ▪ Gout obstruction
syndrome ▪ Hepatitis ▪ Kidney failure
▪ Local ▪ High blood ▪ Severe acute
inflammation pressure respiratory syndrome
▪ Open wounds ▪ Measles
▪ Shingles ▪ Mumps
▪ Ulcers ▪ Ring worm
▪ Varicose veins
▪ Warts
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Additional contra-indications for massage may include:
Temperature Example - the client has a temperature

over 100 F and is feeling unwell. Defer
treatment until well.
Acute traumas Example - Open wounds, recent

bruising, muscle tears, sprained ankles,
contusions, and burns. These must be
avoided during the acute healing
phases.
Skin infections Example - Swelling, redness or heat.

Any attempt to massage in the vicinity
of these areas can make the condition
spread further.
Tumours Example - The presence of swelling

which is inconsistent with recent
bruising. Avoid the area until initial
causes are identified. If in any doubt,
signpost to GP prior to treatment.
Undiagnosed symptoms These should always be signposted to a

GP prior to any treatment.
Pregnancy Extra care should be taken during the

first l6 weeks, with regions
surrounding the abdomen, and lower
back avoided. If the client has
experienced any previous problems,
or sickness during the early stages of
pregnancy, GP clearance is required.
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The table below identifies some of the more common contraindications to
massage along with the actions that should be taken by the massage therapist:
Musculoskeletal conditions
Description Type of contra- Therapist action

indication
Osteoporosis • Temporary • Refer to health care
deferral – practitioner
medical • Gentle massage is
De-mineralisation of contra- indicated
bones (brittle indication • Do not massage over
bones), may be
known osteoporotic
common in the
areas
elderly and may be
• Negotiate
prone to fractures.
comfortable positions
for elderly individuals
Fractures • Temporary • The rest of the body

deferral if can be massaged
acute • Massage other areas
• Local if post of the body to
Broken bone from
acute compensate for this
excessive force, can
restriction
be closed or open,
• Gentle massage of
spiral, greenstick,
muscles adjacent to
oblique etc
the fracture may be
attempted once the
bone is set
Sprains and • Local • RICE if acute.

strains • Avoid area.
Tearing to ligaments • May introduce
and muscles massage in sub-acute
respectively. and chronic stages to
facilitate repair
Inflammation • Local if cause • Avoid area concerned

/ swelling identified • Refer to health care
• Temporary practitioner
May indicate soft deferral and
tissue damage, medical
hematoma, bursitis contra-
indication if
unknown
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Myosistis Usually follows a • Local • Avoid the area once
ossificans blow to the tissue. bone has calcified
The internal
bleeding coagulates
and calcifies
becoming hardened
bone within the
muscle
Osteoarthritis Joint inflammation • Temporary • Refer to health care

and degeneration deferral and practitioner
associated with medical • Extra care to be taken
'wear and tear' referral if around painful areas.
Typically affects acute and • Massage other areas
weight bearing inflamed. and surrounding
joints. • Local if not musculature
acute
Rheumatoid An autoimmune • Temporary • Refer to health care
arthritis disease, which can deferral and practitioner
cause inflammation medical • Massage is indicated
of many parts of the referral if away from painful
body(e.g. skin, lungs, acute and areas or gently around
eyes and internal inflamed. joints if non-acute
organs) as well as • Local if not
joints. acute
Circulatory conditions

indication
Thrombosis / Often occur in the • Absolute • If suspected refer for
DVT legs and may lead to medical input.
an embolism • Follow medical advice
High blood Hypertension can • Absolute • Do not massage
pressure lead to damage of • Seek medical advice
the heart or brain
Raynaud's Vasospasm of the • Absolute – • Avoid massage - refer
syndrome arterioles (usually in Raynaud's to health care
the hands and feet) may be practitioner. If the
usually associated associated condition has primary
with colour changes with causes then massage
underlying may be indicated
pathologic
conditions
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Heart Heart failure, angina, • Absolute • Refer for medical
conditions valve failure input- act on advice
given.
• Vigorous techniques
contra-indicated
Haemophilia Inability of the blood • Absolute • Refer for medical
to clot can be caused input- act on advice
by Warfarin given.
(medication). Risk of • Vigorous techniques
haemorrhage contra-indicated
Diabetes Glucose intolerance • Temporary • Refer for medical input
or deficiency. Insulin deferral and • Follow medical advice.
secretion may be medical • Massage may be
affected by massage. referral indicated if condition
Some insulin is controlled
injection sites may
be tender to touch
Varicose These are the result • Local • Avoid the direct area
veins of valve failure and area below the
leading to damaged vein
accumulate pockets
of blood, often
visible at the surface
of the skin
Nervous system disorders

indication
Stroke Occurs when the • Absolute • If suspected refer for
blood supply to the medical input.
brain tissue is • Follow medical advice
affected, either by a
clot (thrombosis) or
by a blood vessel
bursting.
Neuropathies Neurological • Temporary • Seek medical advice

(e.g.sciatica) symptoms including deferral until first.
numbness, tingling diagnosed. • Therapist may be
sensations, weakness • Local if guided to treat areas
or radiating pain. diagnosed and of soft tissue.
indicated
Areas of Usually a result of • Absolute • Avoid massage - refer
altered skin nerve damage- to health care
sensation
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paraesthesia, practitioner for further
anaesthesia. advice.
Multiple sclerosis,
sciatica, diabetic
neuropathy.
Parkinson's Progressive disease, • Absolute • Seek medical advice.

disease caused by Massage may be
degenerative indicated following
abnormalities in the medical approval to
brain and facilitate movement
characterised by a and flexibility
tremor, or shaking in
the hands and limbs
and by stiffness in
movements.
Multiple An idiopathic disease • Temporary • Seek medical advice

sclerosis (MS) that involves the deferral and first, massage may be
destruction of the medical indicated in sub-acute
myelin sheaths referral if phases and in
around motor and acute and with remission
sensory nerves. symptoms
Other conditions

indication
Skin • Dermatitis/eczema: • Local • Avoid the area
disorders inflammatory skin especially if skin is
condition broken. May not want
• Psoriasis: to treat infectious
inflammatory conditions
condition with
reddened skin
covered in silvery
scales
• Fungal infection: ring
worm, athletes foot
Allergic An adverse reaction • Temporary • Refer to medical

conditions that the body has to a deferral and practitioner for advice.
particular food or medical • May be indicated in
substance in the referral until some cases where
environment, causes allergic allergic conditions can
rashes, hives, be controlled.
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respiratory problems, conditions are
digestive problems, in identified.
extreme situations
anaphylactic shock
Open Broken surface of the • Local • Cover with a dressing,

wounds skin: cut, graze avoid the area
Tumours Abnormal growth of • Absolute • Refer for medical input

tissue, can be Follow medical advice
cancerous or benign
Cancer A mutation of normal • Temporary • Refer to medical

cells into particular deferral and practitioner for further
characteristics that medical advice. Massage may
spread to other cells referral until be indicated in some
and tissues. indicated as situations but may also
part of a be seen as aiding the
treatment metastasis process
plan. through stimulation of
blood and lymph flow.
Mental An inability through • Absolute • Medical input may be
incapacity mental disorder or required. A carer may
mental retardation to need to be present.
carry on the everyday Follow vulnerable adult
affairs of life or to core legislation
for self. A vulnerable
adult
Common Typically caused by • Temporary • Massage in

colds/flu viruses deferral contraindicated in the
acute stages as it may
exacerbate the
symptoms. There could
also be a risk of cross
infection. Advise the
client to return when
clear of symptoms.
HIV/AIDS Acquired Immune • Temporary • Massage may be
Deficiency Syndrome. deferral and indicated once a
AIDS is a disease medical medical practitioner is
caused by the human referral consulted.
immunodeficiency • Avoid open cuts or
virus (HIV), which weeping skin.
attacks and disables • Consider thorough
the immune system. hygiene protocols.
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Referral procedure and communication with GP`s and other professionals
When a client presents with a contra-indication, the massage therapist will need to
signpost the person to their GP for medical clearance prior to any treatment.
Obtaining medical clearance from a GP or healthcare professional
A professional letter should be used to communicate information to a client's GP.

The letter should include the company logo, therapist's name and contact
details and qualifications.
The letter should be addressed to the known medical professional using the correct
title and their surname, e.g., Dr Jones.
The contents of the letter should include the client's name, the treatment they
presented for, a summary of information gathered from the client, including the
contra-indicated condition. The letter should also include an outline of the
proposed treatment (including the potential effects and any risks) and the
precautions that can be taken to minimise risk. This level of information is needed
so that the GP is able to make an informed decision regarding the suitability of
sports massage for the client.
The letter should request GP consent and ask for any further recommendations. It
should be signed and dated and maintained as a permanent record of
communication, forming part of the client's notes.
The GP's response communication should also be provided and maintained
as a permanent written record. Clearance from other professionals,
physiotherapist or osteopath should follow the same procedures.
Referral of clients from a GP or other healthcare professional (HCP)
Some organisations offer care pathways between services, e.g. referral of clients
from a healthcare service to use other services, e.g. massage. In these instances,
the referral process should be formalised and agreed between all professionals
and practitioners to ensure the required client information is transferred using
the correct format.
Paperwork may include:
• Transfer of information record from the GP to the Massage Therapist,
which includes the client's details and relevant medical history, the reason
for their referral, including any guidance for precautions.
• A record of the client's informed consent to transfer information and
participate with the proposed treatment.
• Methods for reporting outcomes and progress (within specified timeframes)
and maintaining communication between services.
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Communication with other professionals
There may also be occasions when the massage therapist may need to signpost
clients to other professional services, e.g. when the guidance and support is outside
their scope of practice.
Other services:
• GP or health professional - medical clearance

• Personal trainer physical fitness advice
• Dietician - nutrition and dietary advice
• Physiotherapist gait analysis or injury management
• Sports coach sports training guidance
• Osteopath spine manipulation
• Counsellor- mental health concerns, e.g. anxiety or depression
• Sports psychologist anxiety related to sports performance
In practice, the only person who can refer clients directly to some of these other
services, e.g. dietitian or physiotherapist, is the client's GP. The massage therapist
can signpost the client to their GP to enable this referral, but they are not qualified
to refer clients directly themselves; it is outside their scope of practice.
Communication with other professionals may include telephone conversations,

emails and face to face communication.
In all communication, the same professional standards should be maintained.
• Client information should only be transferred on a need to know basis and only
if client consent has been obtained.
• Written communication (including letters, emails and client records) should be
clear, concise, accurate, up-to date and appropriate language used.
• During verbal communication, the language used should be appropriate and
the tone of voice, pace of speech and clarity of speech considered. Active
listening should also be demonstrated when other professionals are
responding.
• During face to face communication, awareness should be given to body
language (including posture, eye contact, proximity and space, facial
expressions and gestures). Personal appearance and hygiene should also be
considered.
References
Tosch, H., 2014. Massage and Medication | Massage Therapy Journal. [online] American Massage
Therapy Association. Available at: <https://www.amtamassage.org/publications/massage-therapy-
journal/massage-and-medication/> [Accessed 2 January 2021].
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Lesson 11: Consulting the Client
- Describe influencing factors which need to be considered when

carrying out a consultation.
- Describe key elements of a consultation and how to use
consultation to identify features which may influence
treatment, including physical examination when appropriate.
- Outline possible outcomes following consultation and explain
why a client might be referred.
- Explain the principles of consent and confidentiality.
A holistic massage aims to treat the overall person and offer a treatment to promote
general good health and wellbeing. To accomplish this, it is important that a thorough
consultation is carried out to find out necessary information about the client’s health and
lifestyle to be able to effectively plan an appropriate treatment plan. It is also an important
opportunity for the client to find out more about the treatment/s that you offer and ask any
questions they have. This lesson covers the essential considerations for a professional
consultation procedure.
See Case Study resources for a sample client consultation form.
Preparing for Consultation

Before meeting your client be sure that you are ready to do so. Your treatment room should
be ready, with the couch made up and all equipment that you might need ready to hand.
Check that you have removed any watch or jewellery you may be wearing, and that you are
fresh and presentable. Take a moment to breathe and mentally prepare for your client.
You should ensure that you are punctual for your client as they may arrive early and will
expect the treatment to start on time. The consultation will typically take place within the
advertised treatment time, unless it has been previously stated that the client should arrive
early for an initial consultation or provide a completed information form in advance of the
session. Your consultation will need to start promptly and not overrun into treatment time.
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Consultations should take place in a private,
comfortable area to promote a comfortable open
dialogue between client and therapist and ensure
there is no interruption or distractions. You should
ensure that both you and your client are seated for
the consultation so that you are not looming over
your client. Try to have an open, angled set up, so
that seats are not directly facing each other but are Chairs angled for consultation
positioned slightly askew, without a desk in between.
This helps to create a comfortable environment which doesn’t feel like an interview.
Consultation should always take place before the client undresses for treatment. Not only
so that they are more likely to be comfortable to share and not feel vulnerable, but
importantly there may be a reason (a contraindication) raised in the consultation that
means that massage is not part of the immediate treatment plan for the client. Specific
contraindications are outlined in the next lesson.
Communication
Good communication skills are essential in creating a positive, professional client-therapist
relationship and are a huge part of ensuring that your client is relaxed and enjoys the entire
experience of your practice, thus more likely to return.
Strong communication skills include asking the right questions, listening with attention and
interest, being comfortable with pauses and silences, using appropriate body language.
Positive communication and an effective consultation will contribute to the enjoyment for
the client of the overall treatment. Asking questions is one of the best ways of encouraging
clients to share with you and give you the information you need to treat them effectively.
It is important to understand the difference between closed and open questions so that you
can ask the right kind of question at the appropriate time. Closed questions are ones that
you can answer yes or no to whereas open questions are those that allow the person to give
a broader response.
Open questions are particularly useful when you are meeting a client for the first
time and need to take a medical history quite quickly or when you are talking to a
client you've seen before and you want to find out how they felt after the last
treatment or if there have been any changes to their details that you'll need to
update on their record.
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Whilst it may feel a little stilted at first, once you get
used to the consultation process, you'll feel more
confident to carry it out with ease and this will allow
you to settle in and listen to your clients with genuine
interest and attention, putting them at ease and
building that positive professional relationship. Be very
conscious to actively listen to your client. Not listening
to your client may make them seem that you are not
interested and may not give you sufficient information
to be able to provide the most appropriate treatment
for them.
Listening with attention and interest involves being focused on your client for the duration
of their time with you and concentrating on what they're saying, listening without
interrupting them (though of course you want to manage this effectively so that you can be
efficient in the consultation process allowing them to have their full treatment time without
running over), maintaining comfortable levels of eye contact whilst they are speaking, using
open questions to appear interested and glean more information.
Top tip
Try to remember the small details that your client has shared so that at the next
appointment you can ask them about what they shared with you last time - whether
it's to do with their health, lifestyle or where they may have been going on holiday. If
you are not particularly good at remembering these sorts of details from
conversations, be sure to make a little note on their record card so that you can
review it before you see them next.
Good communication is as much about listening as it is about being able to effectively share
information. You will need to ensure that your client understands you and that you are
being clear and concise to help them do so. Make sure your client understands the reason
for the consultation. If they understand why you need the information you are asking for,
they are more likely to share.
Start with general questions, or more basic personal detail questions to get the conversation
started and ease into the flow to asking about health and lifestyle.
Don’t forget a little confidence and enthusiasm goes a long way!
Using appropriate body language
It is important to consider body language that you use around your clients as this will affect
the relationship with them and how easy and reassured they feel in your presence. Non-
verbal communication is another term for body language. Simply be aware of your body
language and convey an openness and interest through your posture and hand gestures, to
communicate that your client can trust you and share with you.
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Pay attention to your client’s body language, too, as they may share more with you about
how they are feeling through their non-verbal communication than what they say. Look out
to see if they seem particularly anxious or uneasy.
Task: Nervous clients

Come up with as many reasons as you can as to why a client may feel
anxious on arriving to your massage appointment. What could you do, as
the therapist, to minimise the effect of these anxieties (even if you weren’t
aware of the reason)?
For example, a client may arrive anxious to your appointment because they
have never had an Indian head massage before and are not sure what to
expect. Don’t take for granted that clients have had previous massage
experience and be sure to discuss expectations and process with all new
clients. You could even send an information sheet before a new client’s first
appointment.
What should the consultation include?

The consultation should provide the opportunity to:
- establish the client’s reasons for booking a massage treatment.
- make clinical observations about the client which might influence treatment plan, for
example observing their gait or posture as they arrive.
- discuss the benefits of holistic massage and clarify the client’s expectations of massage
treatment and manage these as appropriate, including sharing any limitations.
- confirm what the treatment involves and possible effects.
- gather personal details necessary (e.g., contact details, age, GP details).
- take the client’s medical background, primarily to ascertain if there are any
contraindications to massage or considerations for the treatment plan.
- make a decision on massage medium to use (e.g. based on nut allergy disclosure).
- learn more about the client’s lifestyle for a holistic approach to the treatment plan.
- ask if there are any additional needs or preferences which may alter the treatment.
- signpost or refer to other practitioners as appropriate.
- share your confidentiality policy / data protection policy / etc. with clients.
- answer any questions the client may have.
- agree on a treatment plan.
- establish any process that you typically use for communication and feedback during
treatment (e.g. pressure scale feedback).
- receive informed consent from the client (or responsible person) for the proposed
treatment.
- confirm payment amount and method, if not already done so.
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You should retain a consultation record for each client and record treatment notes for each
appointment they have. You may wish to create your own system to capture and store data
or utilise existing complementary therapy client form systems on the market. Whichever
approach to record keeping you take, you much ensure that it complies with data protection
legislation.
You must check the details of the client consultation form at

each appointment to check for any changes in health or lifestyle
which may contraindicate massage or affect the treatment plan.
Make sure to keep your records up to date and stored
securely.
Physical Assessment
If a client presents to you with pain, you may wish to carry out a physical assessment to
better inform you before deciding whether, and how to carry out treatment.
Important
If a client is presenting with a sharp pain, this can represent
inflammation in the area and massage should not commence
until the pain has turned into a dull sensation.
Recommend the client seeks medical advice.
The assessment process will take a variety of procedures. Firstly, there will be a verbal
discussion, completing a consultation form to determine the clients’ lifestyle, medical
history and also the presenting problem/s. It is essential, that during this process, you find
out as much information as possible on what seems to make any muscular pain worse and if
you feel that the client needs medical advice due to the presence of an injury, then to refer
them appropriately and do not treat. As part of your consultation process, below are other
ways to carry out an assessment.
Observation
One of the best ways to observe the client is naturally, because if you tell someone you are
watching them, they will unconsciously change their actions. Watch them as they walk
across the room, as they sit down, or reach for their bag. Do they have an unusual gait, do
they appear to have one shoulder higher than the other etc.
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• Ideally, ask your client to be dressed in undergarments
(shorts/vest), and stand behind them approximately a
metre away.
• Imagine they have a plumb line running through the
body from head to the feet. The line should run through
the ear, through the shoulder, through the hip and knee
and be in front of the ankle.
• Start by looking at the head to see if it is level, use the
ears as a guide.
• Do the shoulders sit straight? Check the “key hole” (the
gap between the arms and the body) to see if the gap is
wider on one side. Do the hands hang at the same
length?
• Look at the belt line of the clients’ underwear to see if
level, this may indicate scoliosis otherwise.
• Look at the back of the knees to see if the skin creases
are level. Do the knees turn in or out?
• Check for the alignment of the Achilles tendons to see if
there is any thickening of either tendon. Look at the
angle of the feet to see if they are turned in or out.
Range of Motion (ROM)
Another way to carry out an assessment is to determine the amount of movement which
occurs without discomfort or pain. If you are going to carry this out, demonstrate the
movement to your client beforehand and always carry out checks on the unaffected side
first, so that you have something to compare it to, then check for restriction or pain. This is
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purely as a guide and should not be used as a diagnosis but can help you understand that
muscles may be tight or restricted in a particular area.
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Palpation
Palpation is the process of feeling with your hands, sometimes before but definitely during
the massage and it is a continual process throughout the treatment. Palpation will give you
feedback on areas where you need to concentrate on and with lots of experience your
fingers will begin to “see” what is beneath. During palpation, your fingers move the skin
over the underlying tissues so that you are able to determine different textures. This
procedure needs to be carried out very slowly. Below are some of the textures you may feel:
• Soft and pliable – this indicates healthy and relaxed soft tissue.
• Firm and stringy – will usually be tendons, due to their fibrous nature. Firm and less
resilient – this can indicate thickening of the fascia.
• Dip in the contour of the muscle – this can represent a tear in the muscle. Woody
and stringy and may “flick” – can signify adhesions of the fascia.
• Firm, gritty and fairly pliable – can indicate recently formed scar tissue.
• Firm, solid – can signify mature scar tissue.
• Knotty and resistant – this can indicate tension within a muscle.
• Fluid – if there is oedema in the soft tissues, the sensation can be soft and mobile,
however if there is excessive fluid then the skin can feel tight, firm and be painful.
Don’t forget to be sure to record any results of your physical assessment, and anything your
have advised the client, on to the consultation card.
Asking for Personal Information

It is important to consider why you are asking information and whether you need to or not.
You should only collect and store personal information that you can justify having a reason
to have collected. So, make sure that your consultation form is as succinct as possible whilst
still gathering sufficient information for you to carry out an effective holistic treatment.
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You should not make assumptions about
people and record answers that you haven’t
asked the question to. For example, you should
not assume someone’s age or gender and
record that on your record card. If you need the
information, then you should ask everyone the
question.
You should aim to be inclusive when asking
questions, and minimise binary options, by
asking open questions. For example, “how
would you like me to record your gender?” is
more inclusive than asking “are you male or
female?”, as some people do not identify as
either male or female and is certainly more appropriate than making an assumption about
how someone identifies. Remember there are other considerations too. For example, if you
typically ask whether someone is currently menstruating, due to contraindication of
abdominal massage, then you should offer the question to everyone - it is not always visible
from the outside what reproductive organs people have.
It is unlikely that people will be easily offended by questions that you ask, provided you do
make them aware of why you are asking. It is important to note, also, that even questions
you may think innocuous can be upsetting to individuals depending on their circumstances.
For example, asking “are you pregnant?”, or “do you have children?” may illicit an
emotional response in someone who has found out they are unable to have children.
Some therapists find that it is more efficient to give
the client a simple form to complete, either at the
time of booking or on arrival, which covers some
basic personal and medical details you require. It
will likely be quicker for an individual to glance
down a list of contraindications and highlight any
relevant information, than for you to verbally list
each one. It is important, however, to not let a
form replace the bulk of the consultation. You
should review any total contraindications verbally
and use the consultation as an opportunity to
expand and find out more about the person’s
general health and wellbeing and lifestyle.
Consent
It is important that the client gives informed consent for the treatment they receive.
Informed consent is the process by which permission is granted and is only possible if the
client is aware of the risks, benefits, and alternatives to a treatment. It is the therapist’s
responsibility to check that the client has sufficient understanding of the risks and benefits
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(including managed expectations of the benefits) before proceeding with a massage
treatment.
Ideally, clients should sign the consultation form to consent to receiving treatment.
Remember that it may be a chaperone who signs consent on the client’s behalf if they are
unable to give fully informed consent. In lieu of signed consent, clear verbal consent must
be given before a treatment continues.
Confidentiality
Your clients entrust you with personal, sensitive, medical information which you must treat
in strict confidence. It is good practice to share a confidentiality statement with new clients
so that they understand your policy on confidentiality.
Typically, you should not share any personal or identifying information about your clients
with other people. This may not be the case if you work in a salon where clients see multiple
practitioners, and it is in the best interest of clients that their information is securely shared
between therapists.
You must ensure that details held about your clients are
stored securely and in such a way that they are not
accessible by others inappropriately.
You may wish to reach out to other practitioners regarding
a client’s health and wellbeing, for example if there are
medical contra-indications, and this process may involve
disclosing information about the client. This should only be
done with the client’s informed consent.
Most confidentiality policies include a statement to share
with the client that you will share no details of their personal information without express
(often written) consent, unless you believe that the client is a danger to themselves or
others. In this case, you would want to inform other services which could help your client
and you would ideally like to do this with their consent. However, in the event that consent
was not granted, you would break confidentiality to ensure the safety of your client or
others.
It is important to make this information clear to clients, when they are new to you, when
any information changes, and when it has been a while (perhaps a year) since they reviewed
it.
Referral to other practitioners

As a massage therapist it important to remember, and work only within, your scope of
practice. There may be reasons that a client requires referring to medical, or other, services
for a condition that they bring to your attention.
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Where massage is contra-indicated, appropriate guidance and signposting should be given.
Typically, this is referral to a medical practitioner. If a client has brought to your attention a
medical condition that they have not sought medical advice for, or not recently if the
condition has changed, then you should suggest that they seek medical attention. This could
be brought to your attention through the consultation, or you may notice something when
giving treatment that they are not aware of. If in doubt, you should err on the side of
caution and refer the patient.
The health and well-being of the client should come first. It could be that massage is not the
best course of action for a condition. For example, if a client presents with a slipped disc, it
is best to refer client to a good Chiropractor or Osteopath.
It may be that massage is an appropriate and beneficial therapy, but that the client may
additionally benefit from other complementary services too. Perhaps they have highlighted
a desire to alter their diet or to increase their cardio fitness, so you could refer them to a
nutritionist or a personal trainer. Building up a referral network with local practitioners
could help support your business too. Curler (2016) suggests “when we refer out for
complementary, but different services, our clients are more likely to return to us for the
unique benefits our approach provides”.
There may be circumstances where massage is inappropriate for a client, not because it is
medically contraindicated. Examples of situations where this may be the case is if they are
unable to give informed consent, or because they are experiencing some emotional trauma.
Refer to Lesson 2 on the use of chaperones, as this could be useful in certain situations.
Services you can refer to include, but are not limited to:
• GP
• NHS 111 helpline
• Counsellor
• Other complementary therapist
• Member of the social care or nursing team (when working in care)
• Other voluntary or statutory services e.g., Social services, Citizens Advice
Bureau etc.
Task: Consultation
Print a blank consultation card and practice a consultation on

a willing friend or family member. Do you know why you are
asking each question? Are you able to answer any questions
they have?
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References
Curler, G., 2016. Referring A Massage Client to Another Massage Therapist: When and Why. [online]
Elements Massage - Elm Grove. Available at: <https://elementsmassage.com/elm-
grove/blog/referring-a-massage-client-to-another-massage-therapist-when-and-why> [Accessed 1
January 2021].
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Lesson 12: Planning a Treatment
- Identify when a treatment routine may be adapted to

meet the client’s needs.
- Explain how massage techniques can be adapted to suit
the individual characteristics of a client.
Treatment planning starts as soon as your first consultation with your client is underway.
Treatment Routine
You may offer different treatments in your practice and these may be of different times or
types. For example, you may simply offer a 60-minute holistic massage treatment, or you
may offer a choice of a 30-minute massage treatment, a 60-minute massage treatment, and
a 90-minute massage treatment. With appropriate training, you may extend your practice to
include hot stone massage, aromatherapy massage or Indian Head massage so you may end
up having a range of treatments that your client will book onto. You will, of course, have a
generalised plan for what to include in each of your treatment offerings, however it is
important that you consider how to personalise each treatment for every client you work
with. This is the key to great repeat business.
This course provides you with a sample routine for a

full-body massage that can be downloaded.
Don’t forget to take this to your practical lessons!
Your treatment routine will depend on the time allocations you have, and the areas of the
body required to cover. There are commercially acceptable times to consider, too. For
example, a typical full body treatment should be comfortably completed in a 60-minute
massage. You can of course, offer longer full-body massages as part of your service list.
Adapting a treatment
To be able to meet the needs of a diverse client base, it is important that you are prepared
to adapt the treatment you offer. You may need to adapt the massage treatment relevant
to:
• the client’s physiological requirements

• any localised contraindications
• the client’s abilities or disabilities
• any time restrictions the client has
• client preferences
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Massage for the elderly
Massage treatment can be greatly beneficial for elderly clients.
Massage can help with a number of physiological conditions which
are exacerbated as we age, and to soothe and relax, as well as
provide comfort.
Devising a treatment plan

A treatment plan is a proposed set of treatments that form part of an individualised plan for
a particular client. It will be aligned with the client’s needs and wants.
The treatment plan should be based on your recommendations depending on their goals
and can be co-created with the client. It should ultimately be realistic and feasible for the
client. This may include considerations of their schedule and financial circumstances, not
simply their physical condition. The treatment plan should always be created in the client’s
best interest.
You will likely want to outline the following in your summary of the treatment plan:
- treatment area
- duration
- frequency
- style of treatment
Examples
• Maintenance massage: 1 x full body, relaxation massage (60 mins) every 3 weeks.
• Acute shoulder aches: 1 x back and shoulder, deep tissue massage (60 mins) weekly
for 4 weeks, followed by monthly maintenance massages.
After each treatment progress should be assessed. Depending on the progress made, the
treatment plan might need to be revised.
Task: Treatment Planning
Create three fictitious clients.

Summarise their situation and outline a brief treatment
plan for them.
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Lesson 13: Massage Techniques
- Describe the requirements for preparing the client for

massage.
- Describe massage movements and identify appropriate
body areas for use of the movements.
- Outline the effects of the massage movements.
Preparing the client for massage
Following your consultation and with informed consent to continue with a planned massage
treatment, there are important steps to take before the client is ready for massage.
Ensure that the client undresses to their underwear. If the massage is only going to be
covering their top half it is preferable for them still to remove lower-half clothing, however
if they prefer to keep comfortable bottoms on, they can do.
Always protect the client’s modesty by providing somewhere private to change. This may
mean you leave the room and knock to re-enter. Give your client a dressing gown or towel
to cover themselves between changing and laying on the couch.
The client should remove all jewellery, except for a wedding band or similar. Make sure you
have somewhere safe and secure for the client to store their valuables during the
treatment.
Remind client of the treatment plan and ensure they know whether they should position
themselves prone or supine on the couch. Offer help to the client for getting on to the
couch prior to treatment.
Ensure that the client is comfortable with the use of supports, e.g, under ankles, chest,
forehead, knees, head.
Ensure all parts of the client are covered except the area being massaged. Your towel
management routine will need to ensure that you can easily alter the areas covered and
uncovered without causing interruption to the routine. For example, ensure that the towels
across the back form a T shape, with the towel tucked firmly into underwear so that the
lower back can later be easily accessed.
Wipe the client’s hands/feet before and after treatment using wet wipe cloths.
Don’t forget to wash your hands before the treatments begins.
Before uncovering the client use cat paw technique from the feet to the shoulders to
engage the client’s body and physically prepare them for massage.
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Massage Movements
Massage is the combination of various movements Used to manipulate tissues for

both local and overall effects and benefits.
The movements range from gentle stroking to invigorating friction, depending on the
desired effect.
The Basic Massage Strokes
Effleurage a relaxing stroke that is used to prepare the body
Petrissage a firm application of pressure using kneading motions
Frictions firm rubbing and heat-producing techniques
Percussion a striking, wake-up stroke
Vibration a pain reliever which helps loosen tightness in the muscles
Other movements include passive joint movements and linking movement
Effleurage
French: ‘effleurer’ – to touch lightly / skim over
Performing effleurage
• Therapist should be in a striding position.
• Effleurage consists of a soothing,
stroking movement, usually performed
with the palm of one or both hands.
• The hands should be relaxed with
fingers together and moulded to the
shape of the limb or area treated
• Move with the flow of the blood back to
the heart (except when performing
reverse effleurage)
• Hand contact is maintained during the
return stroke, although less pressure is
applied.
• The pressure during effleurage may be
light, medium, or firm / deep,
depending on the massage given, but
always increases at the end of the
Effleurage performed on the back
stroke.
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Uses and effects of effleurage
• Helps therapist to evenly spread the oil or other massage medium
used and to feel out the area for areas of tension or other notable
indicators
• Helps client to adjust to the therapist’s touch and stretch and warm
muscles
• Helps to attain a sense of continuity during treatment by linking one
movement to the next
• Used after stronger and stimulating strokes to soothe the area
• Stimulates blood circulation and a sluggish circulation – to prevent
varicose veins and varicose ulcers
• Increases and improves lymphatic flow and assists in the elimination
of waste products
• Stimulates lymphatic drainage – to prevent edema
• Increases and improves flow of tissue fluid and nutrients to the
tissues – helps to improve and nourish muscle tissue
• Helps to naturally moisturize and nourish the skin by increasing the
functions of the sweat and sebaceous glands
• Helps to exfoliate dead skin cells – therefore improving color and
texture of skin
• Promotes relaxation when using rhythmically slow movements with
light-medium pressure
• Invigorates and stimulates the body when using rhythmically fast
movements with deep pressure
Movements related to effleurage

• Superficial effleurage – slow and light-medium pressure – relaxing
effect
• Deep effleurage – fast and firm – deep pressure – stimulating effect
• Stroking – slow and very gentle pressure – calming effect
Heel of hand stroking
The therapist applies the heel of the hand into

the tissues and re-enforces the hand with the other on top.
Pressure is applied as required following a longitudinal or transverse direction. The hands
are removed at the end of the stroke and re-applied at the start position.
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Forearms stroking
The forearm is usually placed on the tissues concerned

between the radial styloid process and the olecranon process.
The other hand can be used as a guide by holding the fist of the arm in contact with the
client. Pressure is applied with the therapist's body weight and the stroke is usually applied
longitudinally.
Elbow stroking
The elbow is very useful at applying

deep pressure strokes. The elbow can be applied with the other hand supporting the elbow.
The stroke is applied longitudinally at a constant speed and with the pressure coming from
the therapist's body weight.
The therapist should always gain feedback with this stroke as the depth of pressure may be
too uncomfortable for some.
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Finger stripping or chisel
The second, third and fourth digits are applied to the tissues at
a 45 degree angle. The other hand is placed across the fingers to re-enforce and protect
them.
Pressure is applied longitudinally or transversely at a constant speed. The hand can be
removed at returned to the start before repeating the stroke.
Cam and spindle
Place the hand on the surface area of

the client flat with the thumb fully extended. A fist is made with the other hand around the
thumb, which is flat on the surface, placing the knuckles onto the surface being treated.
Pressure is applied longitudinally.
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Petrissage
French: ‘petrir’ – to knead
Performing petrissage
• Working position depends on the direction of strokes
• Petrissage is a compression or kneading type
movement
• The movement may be done with one hand, double
handed or fingers
• Pressure should be upwards, towards the heart
• All movements are firm and stimulating
• Can be performed quickly or slowly
Petrissage performed on the

Uses and effects of petrissage lower calf
• Generates heat and helps break down fatty deposits
• Can cause erythema (redness) and improve blood flow
• Performed slowly, it relaxes underlying structure worked on
• Performed quickly, it stimulates structure worked on
• Increases circulation and speeds up the process of nutrient
absorption
• Stretches tight fascia and muscle fibres thus improves extensibility
• Helps to remove lactic acid in circulation, alleviating stiffness and
refreshing muscles
• Mobilises tissues and improves conditions of muscles by maintaining
tone and elasticity
• Helps to eliminate waste products in tissues
• Stimulates peristalsis and prevents or relieves constipation by
kneading the abdomen in the direction of the movement of the
colon
• Warms tissues and thus helps to ease tension and relieve pain
Movements related to petrissage

• Single handed petrissage – using the heel of the hand, while the other
hand supports the structure worked on
• Double handed petrissage – using the heel of both hands together
• Kneading – single / double-handed, reinforced, alternated palmer (flat-
handed) kneading, circular, thumb
• Picking up (pinching) – manipulation technique where muscle tissue is
lifted away from the bone, squeezed and released
• Skin rolling – manipulation technique where muscle tissue is lifted
away from the bone and rolled down and up in a rocking manner
• Wringing – manipulation technique where muscle is pushed and wrung
back and forth using the palms of your hands
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Other types of kneading:
Palmer
Friction
Latin: ‘fricare’ – to rub or rub down
(Sometimes related to a petrissage movement depending on the literature you
read)
Performing friction
• Friction is used when deep pressure is required
to disperse and free up localized areas of deep-
seated tension.
• Muscle tissue is moved against the bone or
underlying tissue instead of being drawn away
from it. The movement is made with the pads of
the fingers or thumbs; sometimes the heel of the
hand, knuckles or elbows may be used.
• These movements should not merely move the
skin, but the tissue underneath.
• Friction should never be introduced until the
area has been sufficiently warmed up with Thumb friction performed above
effleurage and Petrissage movements. the patella
• Pressure should be applied gradually and

released slowly.
Uses and effects of friction

• A warming movement which raises the temperature of the area and
helps absorption in the part under treatment as it breaks up
inflammatory products and breaks down superficial adhesions
• Loosens adhesions around joints thus improves their mobility
• Breaks down fibrosis or arthritic adhesions
• Provides deep localized massage to connective tissue
• Increases circulation to the area promotes healing of chronic tendon
strain, such as tennis elbow
• Helps to disperse tension nodules and crystal deposits found
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particularly in the trapezius, erector spinae and sternocleidomastoid
muscles
• Performed in areas such as the spine, friction can have an
invigorating and refreshing effect on muscles
• Eases sinus problems and headaches
• Localized hyperemia (increase in blood in a vessel) helps to nourish
the joint structures and increases and maintains joint mobility
Movements related to Friction

• Circular Friction – using fingers or thumbs
• Transverse Friction – working in a crisscross fashion across an area
• Knuckling – using knuckles in a circular motion
Percussion
Latin: ‘percutere’ – to hit
Performing Percussion
• Percussion movements are in general
rhythmical, stimulating, and fast. The
hands usually work alternately, and the
wrists are kept flexible
• These movements are performed with
either:
o cupped hands
o ulna surface of hands and fingers
o loose fists Hacking performed on the back
• All movements should be light, springy,
and rhythmic and therapist should be in side standing position
• Percussion movements should not cause pain or bruising and
should not be used over bony or delicate areas such as the front of
the lower leg (tibia) or the abdomen – except abdominal cupping
• Effleurage or soft kneading should always follow to soothe and relax
the area
Uses and effects of percussion

• Helps to improve and strengthen muscle tone
• Helps to break down and mobilize fatty deposits, e.g., on thighs
• Stimulates and softens adipose tissue
• Helps to improve circulation, creates heat, and increases absorption
of nutrients
• Helps with the elimination of waste products in tissues and muscles
• Performed over the abdomen – it aids digestion and peristalsis
(cupping movements only)
• Performed over the back – increases blood flow to the lungs and
thorax, loosening mucus and easing congestion for a better
interchange of gases
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Movements related to percussion
• Cupping – hands cupped
• Hacking – skin is struck with Ulna border of hands
• Pounding – skin is struck with the Ulna border of the little finger
• Beating – skin is struck with hands held in a loose fist
• Tapotement - a very gentle form of percussion, using the fingertips,
and is used on delicate areas such as the face as an alternative to
percussion. Can also be a safe alternative for the young, elderly or
those with osteoporosis or ME for example.
Vibration
Performing vibration
• Vibration is a trembling movement, either performed with:
o The tips of the fingers - Point vibration
o Or the whole palm of the hand – Flat-handed vibration
• Can also be performed with knuckles, elbows, forearms
• Vibration is usually performed with one hand while
the other hand rests on the body to support the
structure worked on
• The hands or fingers are kept in contact with the skin
so that, though little or no pressure is exerted, the
vibratory movement is transmitted to the deeper
structures of the area under treatment
• The vibration may be static and performed in one
area only, or they may run or move over the area Vibration performed with two
• Can be fast or slow vibration depending on hands on the back
requirement
Uses and effects of vibration

• Before the start of a massage to aid a client’s relaxation (performed
through the towel)
• When muscles are very tight and not responding well to petrissage or
friction movements
• As a pain reliever, which clears nerve pathways and helps loosen
tightness in the muscles, or release tension in ‘knots’
• Can be a very soothing technique or a very stimulating one, depending
on the desired result. It can literally surprise the muscle into releasing
its tension
• Helps to loosen scar tissue and small adhesions
• Used over the thoracic area and upper chest for respiratory problems
such as asthma
• Aids in the loosening of mucus build up
• Over the abdomen to relieve flatulence, intestinal spasm, or mild
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constipation
• Over nerves to relieve pain in the case of neuralgia
• To relieve effusions and congestion in cases of recent injuries
Remember:
• Do not perform vibration where there is inflammation
• Do not apply too much pressure
Movements related to Vibration

• Shaking – The area of the body to be affected is grasped with one or both
hands and then gently and rhythmically shaken from side to side, up and
down or with an ‘in’ and ‘out’ movement
Other Massage Movements

Passive joint movements
• Passive joint movements require the client to relax and let the therapist
gently take a joint (e.g., shoulder, elbow, wrist,
ankle, knee) through its natural range of
movements
• Passive movements help to improve mobility and
release tension
Traction
• A gentle pulling motion, typically used on arms, legs and
fingers or toes. Can be used on the neck with care Traction performed on a finger
• Designed to increase flexibility by stretching the
muscles and connective tissues around the joint
Stretching
• Performed to relax a muscle, for example stretching the neck
• Thai massage is a routine of yogic stretches and pressure
Linking movements
• To maintain the feeling of continuity and flow during the treatment it is
sometimes necessary to insert a linking stroke
• A linking stroke is a gentle stroking motion with one or both hands to
maintain physical contact between completion of one stroke and
commencement of the next
• They are intuitive and optional on the part of the giver, but will enhance
the treatment for both the receiver and the giver
Compressions – Pressure
• Compression is performed by applying a static and direct pressure to either
the belly of the muscle or tendo-muscular junction or an area where there is a
specific restriction, using the thumb, hand or elbow. The aim of the technique
is to help release the tension or restriction. The compression is usually
performed 3 times, maintaining the pressure for between 10-15 seconds.
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Application of compression
Compression is performed by pushing
directly down into the tissue; this
may be accompanied by a slight twist
to the tissue.
It is usually performed using the fist,
but can be applied with thumb, flat
hand, elbows, or even the feet.
Rhythm and Flow

• Good technique depends on the rhythm and flow throughout the massage
• A therapist must work with a client to achieve best results
• A therapist must learn to adapt their routine to suit each client’s individual
needs and recognize a client’s pain threshold
• Ignoring these factors can prevent the massage from being relaxing and
even cause damage
• The therapist should always aim to keep at least one hand in contact with
the client, to prevent interrupting the mood of relaxation and to reassure
the client.
• Contact can be broken where there is a natural break within the routine or
for practical reasons (for example, cleaning hands before starting face
massage or during towel technique maneuvers)
• Movements should flow into one another with no interruptions, use linking
movements to ensure the hands do not leave the body
• Rhythm should be even, continuous, and consistent.
• Rhythm is produced by a swaying motion, backwards and forwards from the ankles,
knees and hips
• Stance, or working position, is important in creating good rhythm and freedom of
movement
Remember that at least one hand should always stay in purposeful

contact with the client during the treatment, unless there is a natural
break in the routine, such as moving to a new treatment zone.
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Direction of massage strokes
Graphic representation of massage strokes direction. Image credit: massageprocedures.com
The choices of massage stroke directions are circular, longitudinal, and transverse. All stroke
directions can be used on the torso, but longitudinal strokes applied to the peripherals
should be deeper and stronger towards the heart and significantly lighter on their return.
Transverse direction is also suitable for legs and arms.
Pressure
• The therapist should start with light strokes and gentle pressure and build
up to deeper strokes and firmer pressure, whilst checking with their client
for their preference
• Use a scale of 1-10 to request feedback on pressure during the treatment.
Make sure you client is aware of this method before starting.
• Depends on the area being treated and sensitivity of tissues
• Is obtained by correct use of body weight transferred through the arms into the
hands, not by pushing harder into the body, squeezing tighter or massaging quicker
• The back and lower limbs require deeper pressure than that for the neck, chest,
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abdomen and upper limbs
• Lighter pressure can be more relaxing, sleep inducing - Ensure that lighter pressure is
not ticklish or irritating
• Deeper pressure can be more stimulating and invigorating and relaxing
Remember
The therapist should always be well organized and start each
treatment prepared and with a positive, focused mind.
Always keep in mind this is your client's healing space not yours
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References
Massage Therapy Techniques. n.d. Swedish Massage. [online] Available at:

<https://www.massageprocedures.com/techniques-procedures/swedish-massage/> [Accessed 1
January 2021].
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Lesson 14: Contra-actions and Client Aftercare
- Describe the contra-actions that may occur during and

after a treatment and how to respond appropriately.
- Explain the after care and home care advice that should
be provided to clients.
During Treatment
It is important to regularly check your client’s satisfaction and comfort throughout
treatment. This can be done verbally, by asking the client, or non-verbally, using visual cues
to assess the client’s situation. Before the massage begins, be clear with your client that
they are encouraged to express their feelings or requirements during the treatment – not to
‘suffer in silence’.
When asking for verbal feedback during a massage, questions should be kept simple. Asking
closed questions allow for a straightforward response, however asking (simple) open
questions might allow your client to give a more honest response and avoid response bias
where the client simply answers what they think you want to hear. Consider ‘are you warm
enough?’ versus ‘how is the temperature for you?’; ‘how is the pressure for you?’ versus
‘would you like a little more pressure?’. What sorts of answers do each question illicit?
It is also possible to collect information about how comfortable and satisfied your client is
with the treatment without asking questions. You might notice that your client is fidgety, or
starts drifting off to sleep. Perhaps they wince, or visibly relax during a particular
movement.
Task: Mid-treatment Feedback
Make a list of simple questions that you could ask during

a treatment to ascertain if your client is comfortable.
Then consider whether you would be able to identify the
answer to the questions with visual cues or not.
A client could experience a number of contra-actions during a treatment. You will need to
be familiar about what can happen and know how to respond appropriately. Remember,
part of a good consultation is informing your client of not only the desirable effects of
massage but also any possible effects which are less desirable. If you have addressed, prior
to treatment, that something might arise, it is likely to minimise any discomfort or
embarrassment your client might experience.
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Possible contra- Likely caused by Appropriate action
actions include
Desire to sleep State of relaxation Allow client to dose. Rouse gently at the end of the
treatment. The client may be disoriented and
unsure of where they are.
Perspiration Continue massage confidently to reassure the client

that it is nothing to be concerned by. If the client
seems particularly distressed or uncomfortable, you
could provide a tissue or small towel. If it is profuse
(or unusual for that client), check if the client is
feeling okay as it could indicate a fever.
Flatulence Relaxation. No action needed.

Movement of wind
in abdominal or
lower back
massage.
Micturition (need for You will be unaware of this unless a client shares
urination) their need. If a client asks to use the bathroom
during a massage, or course allow them to. On their
return, simply restart the massage with some
additional effleurage movements.
Runny nose Position If you are aware of it, you could offer your client a
tissue. Keep tissues on your trolley so they are in
easy reach.
Reaction to massage Allergy or Stop the treatment and place a cool damp cloth
medium sensitivity over the area. Assist client with first aid if
appropriate. Share the details of the label with the
client for their information.
After Treatment
• After a massage you should ensure that you wash your hands.
• Provide your client with freshwater before helping them off the bed, using
appropriate towel management to protect modesty, and allowing them to come
back to full alertness in their own time.
• You should discuss with your client any findings during the massage and allow them
an opportunity to give any feedback or share any comments.
• You should remind clients about the potential of a healing crisis an aftercare actions
that they can do to minimise the effects or any contraction's to massage.
• As part of a holistic massage, you should discuss home care including a few
recommendations for them between now and their next treatment.
• The client should be reminded of their treatment plan and encouraged to rebook if
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they have not already done so.
Treatment Findings
Following a massage, you should share your observations and findings with your client. This
includes any areas of tension, limited (or positive!) range of movements, any lumps or
bumps or unusual markings that you notice. This can help in the early identification of any
conditions that the client may not notice themselves – for example a mole on a client’s back
which may appear to have changed in size, shape or colour since the last treatment. You can
help to make your client more aware of their body but should be cautious not to alarm and
certainly not to diagnose anything!
If you do notice lumps or bumps, for example, on a client’s body which have not been
highlighted in the consultation, but constitute a local contra-indication, simply continue the
massage avoiding the area. Make sure to mention this to your client when sharing
treatment findings.
You should record any findings in your treatment notes. See Lesson 15.
Healing Crisis
After treatment, many reactions can be experienced - this is a positive result and is also
known as the ‘Healing Crisis’. It is important to explain to the client that this is a normal
reaction to a treatment, especially if the client has never had a massage before.
With regular treatments and as the body starts to heal and re-balance these symptoms
will subside. Any symptoms experienced should subside within 24 hours.
Typical contra-actions or ‘Healing Crisis’ symptoms
Symptoms are individual, they vary from client to client, and may include:
• Erythema (redness) on areas which included deep tissue movements.

• Tiredness and altered sleep patterns leading gradually to increased energy levels.
• Muscular ache and/or headaches with gradual relief from symptoms, due to the
nerve fibers responding to the deep work undertaken.
• Heightened emotions or vivid dreams or positive mood changes, due to the
positive release of deep held feelings and emotions.
• Increased need for urination (micturition) or bowel movement (defecation).
• Mucus release and/or runny nose.
• Spots may appear on the skin.
• Increased thirst.
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Aftercare
To help counter the impact of any contraction's and enhance the full benefits of massage
treatment the following can be advised:
• Take time out to relax and practice self-care.

• Avoid strenuous exercise for the remainder of the day – light, stretching exercise can
be beneficial.
• Avoid stimulants - such as tea, coffee, alcohol, nicotine, or any non-prescription
drugs.
• Rehydrate with water or herbal teas.
• Avoid heavy meals – eat a light, healthy meal instead.
• Get plenty of rest as you may feel tired after treatment.
Task: Aftercare Advice
Design a leaflet that you could give to clients that

explains the healing crisis and gives aftercare advice to
help them minimise negative effects and maximise the
positive effects of massage.
Home Care Advice

Home care advice are suggestions that you give to your client to enhance their lifestyle in
their day-to-day life. Advice given should be specific to the client, referring to the
consultation and any treatment findings. Homecare advice offers a good way to
demonstrate an understanding of your client as a whole and is a beneficial part of a holistic
massage which can aid building up a professional relationship with your client.
Home care advice can include lifestyle suggestions such as ways to enhance a healthy diet,
promote good mental health and minimise stress, or increase physical wellbeing. Try to
keep recommendations goal-oriented, specific, tangible, and measurable. For example,
rather than “drink more water”, you could say “you should be drinking between 6-8 glasses
of water a day. Since you only drink one glass a day currently, aim to increase your intake to
three glasses per day between now and next week. Try having a glass with each meal”.
Stretches
Including a stretch recommendation in your homecare advice gives your client a specific and
tangible action to carry out between treatments which will aid their physical wellbeing. Your
client may have already highlighted an area that is prone to tightness or aching or you may
have noticed a sign during treatment, such as limited range of motion in the shoulder. This
will help you to give a personalised stretch suggestion. Alternatively, you may be informed
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by lifestyle details from the consultation, such as the client working at a desk for 9 hours per
day.
Stretching has many benefits which support the desired outcomes of massage, so they are a
good way to maximise the benefit of your treatments.
• Increased physical efficiency

• Decreased risk of injury
• Increased circulation to joints (providing oxygen and nutrients)
• Increased range of motion
• Developed neuromuscular coordination
• Improved balance
• Improved posture
• Decreased risk of lower back pain
• Reduced stress
• Increased energy and enjoyment
Stretching guidelines to share with clients:
• Always warm up before stretching

• Stretch slowly and exhale as you gently stretch the muscle
• Stretch the intended muscle until you feel a mild tension. Stop the
stretching if you feel pain
• Hold your stretch between 15 to 30 seconds
• Don’t bounce the stretch. Slow and steady stretching is more effective
Task: Home care advice
Go back to a sample consultation you completed in lesson

11, or complete a new one. What home care advice would
you give based on that client’s lifestyle responses?
Write down three suggestions.
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Lesson 15: Evaluating and Recording Treatments
- Describe the methods of evaluating effectiveness of

treatment.
- Identify what information about clients / treatments
should be documented.
- Describe the requirements for record keeping as a
massage therapist.
Evaluating Treatments
At the end of each treatment, the client’s psychological and physiological reactions should
be recorded on the consultation form. You should ask your client for feedback after each
treatment but should also document your own observations.
You should also document any physical observations, or findings, you noticed while giving
the massage treatment. Remember to share these with your client as part of the post-
treatment conversation. You could record findings on a diagram such as the one shown. Use
symbols or initials to keep this process quick and simple but be sure to make a key of your
symbols!
An example of a full body diagram which can be used to document findings
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A summary of the treatment given should be documented, including areas massaged and
specific movements used.
It is important to evaluate the treatment against the consultation to identify whether the
treatment achieved the desired outcomes and to what extent it was effective in doing so.
You should note if there was anything you would change next time, for example, you may
re-assess the massage medium used.
You must note down on the consultation card any advice (after care or home care advice)
that you give to your client.
Following a treatment, you may consider changes to the client’s treatment plan. Be sure to
discuss these with the client and make a note of what is agreed. You should note anything
to look out for next time to help judge client progression.
It is good practice to also record your own reflections of the treatment and evaluate your
performance against your professional standards. How well did the massage treatment
meet your own expectations? Is there something you should work on next time? More
about reflection is explored in the next lesson.
Producing, maintaining and storing client records

The importance of accurate and confidential record keeping
An essential part of the massage therapist's role is to maintain accurate records

of client assessments and treatments.
Records need to be maintained for the following purposes:
• To adhere to legal requirements
• To provide an informed and professional service
• To offer protection to the client
• To inform safe and effective treatment
• To improve accountability
• To provide evidence of practice
• To respond to complaints, queries or legal requests
• To protect the therapist against litigation
Information to record
To practise safely and effectively a variety of information needs to be gathered and

recorded. Clients should be advised of the reasons why records need to be
maintained, e.g. a professional and legal requirement, and how they are being
stored. They should also be informed that they have the right to access their records.
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The information to gather and record should include:
Client consultation Personal details, e.g. name and contact details, medical
notes history, activity and sport history, presenting needs, e.g.
purpose for attending and desired aims of treatment,
contra-indications or cautions, subjective assessment
information, objective assessment information, analysis of
Informed consent information and planned treatment.
Treatment plans For assessment and treatment (signed by therapist and

client)
Type of treatment, effects, benefits, techniques, medium

used, response of the client, modifications made during the
Records of
treatment (initialled by the therapist). These should be
communication
update after every treatment
Records of Clients - Letters and emails

aftercare advice Healthcare professionals - Referral notes, X-rays, and
transfer of information records from other
professionals
Principles of recording treatments
The key principles for recording treatments and maintaining professional records
to meet legal requirements include ~Chat all records should be:
• Legible and clear, e.g. typed using black ink or if handwritten using
permanent black ink (not pencil) and using neat handwriting.
• Recorded in a logical format, e.g. the use of consultation sheets or screening
forms.
• Accurate and factual and supported by evidence, e.g. the information should
be correct and objective, no subjective or judgemental comments and no
abbreviations; records should never be falsified.
• Completed within 24 hours of the treatment, the date of treatment and date
of record should be recorded.
• Initialled by the therapist when corrections are made or information added.
New records should be attached to the
• original record.
• Corrected using a black line to strike through text. Correction fluid should not
be used.
• Signed by the therapist on each page.
• Protected, e.g. electronic records should be password and firewall protected
and back up regularly. Written records should be stored in a secure and
locked cabinet.
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Legal requirements for the storage and disposal of records
The maintenance, transfer, storage and disposal of records containing personal

information is governed by various legislation, including data protection,
confidentiality and information governance. Non-compliance with this
legislation is a criminal offence and may be prosecuted in a court of law.
Guidelines for adhering to legislation include that all client record and
information should:
• Be used for the purpose for which it was obtained and not passed onto to
other persons (including family members)
• Be transferred and seen by relevant parties and client consent must be
gained before transferring records.
• Be transferred in a secure manner. This includes ensuring that emails are
secure and any transfer of verbal information should only occur between
relevant professionals.
• Be stored in a securely, e.g. using a locked filing cabinet or password
protected access on an electronic or computer based system.
• Be retained for eight years for all adult clients and for children records must
be kept until their 25th birthday.
Be destroyed securely when they are not needed, e.g. shredded.
REMEMBER
Your client has a legal right to access the data, including all notes, that you
store about them. Do not document anything that you would not wish for
them to see.
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References:
Salon Gold. 2018. Therapist Counselling Notes and Your Client Record Keeping Guide. [online] Available at:
<https://www.salongold.co.uk/holistic-complementary-insurance/holistic-therapist-insurance/therapist-
insurance-client-records> [Accessed 29 January 2021].
HSE (1974). The Health and Safety at Work Act. Available from:
http://www.legislation.gov.uk/ukpga/1974/37/contents. Accessed on: 27 October 2015
HSE (1981, amended 201,3). First Aid at Work [online] Available from:
http://www.hse.gov.uk/pubns/books/l74.htm. Accessed on: 27 October 2015
HSE (1992, amended 2oo4). Manual Handling Operations Regulations. Available from: http://
www.hse.gov.uk/pubns/books/l23.htm.Accessed on: 27 October 2015
HSE (2014). Dislay the Health and Safety Law Poster. Available from:
http://www.hse.gov.uk/simple-health-safety/display.htm Accessed on: 27 October 2015
HSE (2014). Five Steps to Risk Assessment. Available from:

http://www.hse.gov.uk/risk/fivesteps.htm. Accessed on: 27 October 2015
HSE (2014). Health and Safety Regulation. A Short Guide. Available from:
http://www.hse.gov.uk/pubns/hscl3.pdf. Accessed on: 27 October 2015
Leland, K. and Bailey, K. (1999). Customer Service for Dummies, 2nd edition. Wiley
publishing, Inc.
Website references
National Society for the Prevention of Cruelty to Children: http://www.nspcc.org.uk
Health and Safety Executive: http://www.hse.gov.uk
Disclosure and Barring Service (DBS); https://www.gov.uk/dbs-check-requestsguidance-

for-employers
Health and Social Care Information Centre: http://systems.hscic.gov.uk/infogovSports Massage
Association (code of ethics and conduct): http://www.thesma.orgInstitute of Sport and Remedial
Massage: http://www.theisrm.com/terms.phpComplementary and Natural Healthcare Council (code
of conduct): http://www.cnhc.org.uk
Federation of Holistic Therapists (FHT): http://www.fht.org.ukThe council for soft
tissue therapies: http://www.gcmt.org.uk

Notional Institute for Health and Care Excellence (NICE): http://www.nice.org.ukDepartment of Health:
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Lesson 16: Professional Development: Reflective Practice & Lifelong
Learning
- Describe the basic elements of reflective practice.

- Self-reflect in relation to personal growth as a
massage therapist.
- Identify lifelong learning opportunities to plan for
self-development
- Explain the importance of acting on evaluation to
improve treatment.
A study of the perceptions of what makes a successful massage therapist (Kennedy & Munk,
2017) highlighted four key themes for success:
• Effectively establish therapeutic relationships (with clients)

• Develop massage therapy business acumen
• Seek valuable learning opportunities
• Cultivate strong social networks
This lesson looks at ways that you can reflect upon ways to ensure that you become a
successful massage therapist. In order to highlight areas that you can continually develop
and hone your skills, you should partake in reflective practice.
What is reflective practice?

Reflection is an “active, persistent and careful consideration of any belief or supposed form
of knowledge” Dewey, 1933.
Reflective practice is essentially thinking about, or reflecting, on what you do or have done.
It is about considering our experiences and learning and developing from them –
experiential learning. Self-reflection is an important tool that promotes lifelong learning.
Reflective practice involves forming strong, cyclical habits which raise your awareness and
promote critical analysis of your own actions. Reflection is about “learning from experience”
(Spalding, 1998) and “thoughtful deliberation” (Tickle, 1994)
It can involve:
• Learning to pay attention

• Listening to ourselves
• Noticing patterns
• Changing what we see and how we see
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Our attitudes, beliefs, and values
As adult learners, we come to the position
of learning new skills with a strong set of
knowledge, abilities, values, beliefs, and
experiences already set in ourselves. It is
important therefore, to make time to
review what we are learning and analyse
how our actions fit into existing
connections in our brains and how we can
develop and process them to continue to
learn and grow. Reflective practice helps
us to cement learning and achieve our
goals.
Whilst it may seem that reflection,
thinking about an experience or action, is
a cognitive process, it can also be
emotional and physical. Part of being reflective involves challenging our existing thinking
and allowing different perspectives to support our learning.
Reflective practice is the systematic process of engaging in, and documenting, self-
reflection. Reflective practice can also involve other people.
A key purpose is of reflective is to enhance learning and continual development of skills,
attitudes, or beliefs.
Why be reflective?
Being reflective underpins continual professional development (CPD). Professional
aspiration is about moving beyond the norm and believing that personal and professional
change can be made despite barriers. Having an aspiration to change and grow and develop
your practise. For change to happen, we need to be critically reflective. Being reflective
allows you to consider what steps to take to help develop and grow.
Key reasons to reflect:
• To make change happen • To seek reassurance

• To gain confidence • To gain knowledge
• To assess a critical incident • To work more effectively with
• To resolve a problem others
• To develop a specific skill • To celebrate successes
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When should we practice self-reflection?
There are no hard and fast rules about when reflection should take place. However, there
are some different approaches.
You can reflect:
• Rapidly, during an action – for example you may need to reflect during a massage
and alter your routine depending on an unexpected finding. This is often a reactive
reflection.
• Thoughtfully, during – whilst you are giving a massage you might take a moment to
reflect on the treatment and start the evaluation process.
• Briefly, after – part of reflective practice is about analyzing an action or experience.
After it has happened you may use a reflective tool to reflect on it.
• Systematically, over a period of time – you may reflect on a series of actions and
experiences to get a broader picture, or to reflect on a specific focus for
development.
Schon’s theories around reflective practice consider that we can carry out “reflection IN
action” and “reflection ON action”.
Reflection in action is the ‘thinking on our feet’ process. We engage with the situation we
are in and are influenced by it. We will consider what’s gone before, what might come, our
own repertoire and our frame of reference. This allows us to build theories and responses
that fit the new/current situation, as we see it already existing as similar or different to our
other ‘familiar situations’. This helps us to identify and necessary direction of change.
Reflection on action is the retrospective process of reflecting after something has happened.
It affords us the space to think more deeply and meaningfully to explore what was
happening, why we acted as we did, etc. This allows us to develop a system of reflective
practice.
Note: If you are reflecting on a specific massage treatment, or a learning experience, or any
other specific event, it is recommended to do so as soon as possible after the event so that
your recollection of the event is as reliable and accurate as possible.
How to be reflective
There are many different models of reflection, many of which have similar elements.
Reflective practice is often a personal experience and people have different ways that work
for them.
Essentially the process is:
• We experience or are exposed to a situation

• We feel emotion
• We process information or feedback
• We internalise through analysing the available information
• We apply the analysis to subsequent experiences
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We will review some theoretical models of reflection and consider some tools/methods for
processing reflection.
Models of Reflection
Kolb’s Model of Experiential Learning

Kolb’s cycle of reflective practice is probably the model of reflective practice or learning
which has been most used, written about and adapted. It is essentially a process of ‘Do –
Review – Learn – Apply’ which leads back to do. A limitation of Kolb’s cycle is that the
‘review/reflect’ element requires an active approach to reflection. Some learners find it
helpful to embed another reflective model within Kolb’s cycle.
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Gibbs’
Gibbs (1984) provides a framework to build on the reflective element of experiential
learning.
‘It is not sufficient simply to have an experience in order to learn. Without reflecting upon
this experience it may quickly be forgotten, or its learning potential lost. It is from the
feelings and thoughts emerging from this reflection that generalisations or concepts can be
generated and it is generalisations that allow new situations to be tackled effectively.’ (Gibbs
1988)
Using this 6 step model should help to identify your strengths, areas for development and
actions you can take to enhance your professional skills. Starting with the description as
step 1, steps 1 - 3 relate to what happened during the experience and steps 4 - 6 focus on
how you could improve on the experience and outcome in the future.
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Step 1 – Description
This should be a brief description of the experience or event to set the scene and give
context.
Step 2 – Feelings
Consider what you were thinking and how you felt before the experience. How did you feel
during the experience? How did you feel after the experience? This is another short
descriptive step, rather than being analytical.
Step 3 – Evaluation
Evaluation looks objectively at both positive and negative aspects of the experience.
Describe key elements that went particularly well. Was there anything that did not go well
or did not work? If appropriate, you can include what others did or did not do well.
Step 4 – Analysis
Analysis attempts to explain why the experience was positive or negative and should form
the largest section of your reflection. Take into account points made in the previous steps
and identify any factors which helped you e.g. previous experiences, carrying out research
or consulting with others. Consider your role in the experience and how you contributed to
the success of this experience? If things did not go to plan, why do you think this was e.g.
lack of preparation or external factors beyond your control? It can be useful to consider
other people who were involved in the experience. Did they have similar views or reactions
to you? If not, why do you think that was the case?
Step 5 – Conclusion
Focus on what you have learned. Are there any skills you developed as a result of the
experience? If so, how would you apply them in future experiences or situations? Are there
areas of knowledge or particular skills you now need to develop? Is there anything you
would do differently in the future? Try to give specific examples.
Step 6 – Action Plan
What specific actions can you now take to build on your knowledge or skills? You could
include any training that would benefit you (formal or otherwise), as well as identifying
sources of information or support (people or resources).
Rolfe et al.
Rolfe, Freshwater and Jasper (2001) created a framework for reflection based upon their
work with nurse practitioners. It is a simple process of three key questions: what? So what?
Now what? Each question in the stage has a series of underpinning questions which can
help to frame your thinking.
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What? So what? Now what?
Describe the experience in Describe why this experience Describe next steps you will
detail was significant take
What happened? What critical questions does How will you apply what you
What did you observe? this experience cause you to learned from your experience?
What was your role? ask? What would you like to learn
What issue is being addressed What made an impact on you? more about?
or population is being served? How does it make you feel? What follow-up is needed to
What were your initial What broader issues arise address any challenges or
expectations? from the situation at hand? difficulties?
What was good/bad about the What did you learn about What information can you
experience? others and yourself? share with others?
What did you learn from the How were you different when If you could do it again, what
experience? you finished this experience? would you do differently?
What part of your experience What values, opinions, Have your career options been
was most challenging? decisions have been made or expanded by your experience?
What part did you find changed through this How will your efforts on this
surprising? experience? experience contribute to your
What did you already know What new skill did you learn? career?
about the topic you explored? What impacts the way you Where do you go from here?
Who did you work with? view the situation/experience? What is the next step in the
process?
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Task: Self-reflection template
Pick a reflective model and create a simple template that

you could use to reflect after giving your next massage
treatment.
Further Reading: Towards Reflective Practice in Massage Therapy
Methods of Reflective Practice

There are numerous different tools and methods that you can utilise for Reflective Practice.
A few suggestions are listed here.
Journal / Treatment Logs

As best practice, you should keep treatment logs for each treatment that you give. This can
be held in a wide number of ways, and can include your reflective practice. Review the
previous lesson for more information on record keeping and documenting treatments.
In addition to treatment logs, or instead of storing your reflective practice on each
treatment log, you could keep a journal to document your reflective practice. Rather than
being assigned to each client, this becomes a chronology of your reflective practice over
time and can incorporate reflections of other experiences that influence your practice,
beyond simply each treatment.
Video-based self-reflection
A well-documented and growing method of reflective practice is to record and review your
practice using video. There are a number of different tools available to do this, but at it’s
most simple, a standard digital camera or smart phone and mini tripod should do the trick!
Make sure that you get consent from your client to record a treatment and be clear with
them what the purpose of the recording is.
When you review a recording, you may be looking to reflect on a particular area for
development that you’ve already identified, or you may review a massage treatment from
start to finish, including the consultation to highlight area/s in which you would like to
improve your practice. Review the footage of the areas you wish to improve upon and set
yourself targets for improvement. Then record another treatment in a couple of weeks and
compare your practice. Have you developed that skill? Does it feel natural or conscious?
How can you continue to improve? You don’t need to review whole hours of video, but just
select a small part of the treatment. A 10-minute section is a good amount to aim to reflect
upon.
Peer Feedback / Mentoring
Consider working with another practitioner to receive feedback and support. This could be a
reciprocal arrangement whereby you each offer feedback on one another’s practice. You
could offer massage swap, you could share videos of your massage practice (with client
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consent!) or share supporting resources (such as forms, pricing list or patient care
documents) for feedback.
Working with someone else who is trained and experience, in either a peer/equals or
mentor/mentee relationship, is great way to get constructive critique of your practice to
help you to develop and hone your skills.
CPD Plan and Log
Having a CPD plan to document how you intend to develop your practice and achieve your
goals is important to help keep yourself accountable to your ongoing development. Align
your planning with short-term, medium-term, and long-term goals. You should keep a
record of any CPD experiences that you have undergone and evaluate the effectiveness of
them against your goals. This can help inform your CPD plan.
CPD logging is important to not only document your activity and progress, but to have as a
reference for updating your CV and also to evidence for renewal of insurance or
professional body membership.
Personal Development Plans
It is important to remember to view yourself holistically and consider your own personal
development needs alongside your professional development. What are your personal
strengths and weaknesses and areas that you would lie to develop in your personal life?
How can you incorporate these into your professional world?
Goal-oriented reflection
You can use reflective practice to identify areas for development and to help set goals, but
you can also use reflective practice to work towards goals that you have already established.
Goal Setting
To support any professional development, it is important to have short-term, medium-term,
and long-term goals established. This will help to focus your CPD plans and visualise what
your end-goals are. These goals can be dynamic and change over time, but it’s useful to take
the time to set them so that you have purpose and direction.
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SMART Targets
To make sure that your goals are well thought out, you could use a SMART Target
framework to create them.
SWOT Analysis
Another tool to help with goal setting is a SWOT analysis. It includes looking at strengths,
weaknesses, opportunities and threats. You can use it broadly to analyse yourself, or your
company for example, or alternatively you can conduct a SWOT analysis on a specific goal to
help develop your plans for success.
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Applying Reflective Practice to your Massage Course
As a trainee massage therapist, and as you progress in your practice as a qualified therapist,
you should regularly reflect on your learning experiences.
Within this course, your case studies must include reflective practice. This is your
opportunity to reflect on what you did and what you learnt whilst working with your client
and, importantly, what you can take from that learning to develop your practice for the next
client. It is important not to see this as a ‘box-checking’ exercise for your course, but as a
positive habit to form to support your professional development and contribute to your
lifelong learning and career development.
Lifelong Learning
A healthy approach to professional development is to consider that we are all lifelong
learners.
Setting goals and creating plans for continual professional development is a good way to
commit to lifelong learning. See the attached CPD plan template and write down some
considerations.
It is important to log and evaluate your CPD so that you can keep your CV up to date,
evidence your progress and inform your goals for development. It is important to note that
regular CPD is often a requirement to maintain membership of professional bodies.
Task: Self-reflection template
Download the CPD plan and consider what actions you

could take in the next month.
Your CPD plan can include revision, learning of theory, observing peers, honing skills,
attending courses, adding new skills to your repertoire, and any number of other activities
which help your professional practice.
As a massage therapist, your CPD could focus on your consultation skills - such as developing
active listening skills through reflective practice and applied research, your massage practice
- such as attending and advanced massage skills course, your business skills – such as
attending a short course on accounting.
Next steps…
Take a look at the Brighton School of Massage website and
explore the range of courses on offer. Which courses interest
you for your next phase of your development?
Page 154
References
Kennedy, A.B, Munk N. Experienced Practitioners' Beliefs Utilized to Create a Successful Massage
Therapist Conceptual Model: a Qualitative Investigation. Int J Ther Massage Bodywork. 2017 Jun
30;10(2):9-19. doi: 10.3822/ijtmb.v10i2.367. PMID: 28690704; PMCID: PMC5495388.
Page 155

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Introduction & Overview

Anatomy & Physiology Online study Pathology Assignment: Pass / Refer

Complementary therapies Online study Assignment: Pass / Refer

Business practice Online study Assignment: Pass / Refer

OBJECTIVES OF THIS LESSON

(©) Copyright 2022 Brighton School of Massage. All Rights Reserved.

Medical therapies Including physiotherapy, osteopathy, occupational

Physical therapies For example yoga therapy, Pilates, exercise therapy,

Talking and psychological Including counselling, drama therapy and dance

For example, Somatics, Reiki, energy medicine,

Task: History of Massage

Review the attached history of massage timelines. Highlight

Physiological benefits of massage

Massage uses touch to relax the body. Extended

Massage stimulates blood circulation and assists the

Psychological benefits of massage

As much as the reduction of stress have physiological

A massage treatment can provide an opportunity for mindfulness and grounding

Massage provides a soothing and comforting alternative or addition to verbal therapeutic

Spiritual and energetic benefits of massage.

Whilst it is uncommon for massage to evoke negative effects, occasionally contra-actions

Task: Benefits of Massage

In your own words, summarise three physiological and

The link between Holistic / Therapeutic massage and Traditional Swedish

OBJECTIVES OF THIS LESSON

▪ Understand how to produce, maintain and store client records

As a professional Massage Therapist we are governed by various legislations which

Failure to comply with legislation may result in:

RIDDOR - Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (2013)

Manual Handling Operations Regulations (1992).

•First aid room {depending on number of employees)

•Emergency contact numbers for all staff and service users

Noise at Work Regulations 1989

Key guidelines include:

The Equality Act 2010

This is the overarching legislation for equality and diversity, it encompasses

Employers' Liability (Compulsory Insurance) Act 1969

Provision and Use of Work Equipment Regulations 1998

Key guidelines include ensuring:

The Regulatory Reform (Fire Safety) Order 2005

Key guidelines include ensuring:

Personal Protective Equipment at Work Regulations 1992

Key guidelines include ensuring:

Data Protection Act 2018 –the UK implementation of the General Data

This protects the client's right to confidentiality.

Key guidelines include:

• Information should not be disclosed to any third party

Management of Health and Safety at Work Regulations 1999

Health and safety procedures should not be seen as box

Particularly if you are self-employed or an employer, it is important to be aware of the

Health & Safety in Practice

…get some help with your health and safety duties

Some examples of things to consider:

When thinking about your risk assessment, remember:

If you need further controls, consider:

The likelihood of a client with a contra-indication experiencing a negative reaction

ELIMINATE REDUCE ISOLATE CONTROL

Tumble drying towels has the potential to be a fire hazard.

OBJECTIVES OF THIS LESSON

▪ Describe how you can keep yourself safe and healthy as a

How can massage therapists protect and take care of themselves?

Receiving body massage can help improve posture as it:

Maintain correct posture during massage treatments:

front leg to get momentum to your stroke.